From secondary to primary prevention of progressive renal disease: The case for screening for albuminuria

From secondary to primary prevention of progressive renal disease: The case for screening for albuminuria. Many subjects nowadays present with end-stage renal failure and its attendant cardiovascular complications without known prior renal damage. In this report we review the evidence available to strongly suggest that the present practice of secondary prevention in those with known prior renal disease should be extended to primary prevention for those subjects in the general population who are at risk for progressive renal failure, but who had never suffered from a primary renal disease. We show that such subjects can be detected by screening for albuminuria. Elevated urinary albumin loss is an indicator not only of poor renal, but also of poor cardiovascular prognosis. In addition to diabetic subjects who are at risk for albuminuria, we also show that hypertensive, obese, and smoking subjects are more susceptible. We suggest that therapies that have been shown to lower albumin excretion, such as ACE inhibitors, angiotensin II receptor antagonists, and statins be started early in such patients to prevent them from developing clinical renal disease and its attendant cardiovascular complications

Low Nephron Number and Its Clinical Consequences

Epidemiologic studies now strongly support the hypothesis, proposed over two decades ago, that developmental programming of the kidney impacts an individual’s risk for hypertension and renal disease in later life. Low birth weight is the strongest current clinical surrogate marker for an adverse intrauterine environment and, based on animal and human studies, is associated with a low nephron number. Other clinical correlates of low nephron number include female gender, short adult stature, small kidney size, and prematurity. Low nephron number in Caucasian and Australian Aboriginal subjects has been shown to be associated with higher blood pressures, and, conversely, hypertension is less prevalent in individuals with higher nephron numbers. In addition to nephron number, other programmed factors associated with the increased risk of hypertension include salt sensitivity, altered expression of renal sodium transporters, altered vascular reactivity, and sympathetic nervous system overactivity. Glomerular volume is universally found to vary inversely with nephron number, suggesting a degree of compensatory hypertrophy and hyperfunction in the setting of a low nephron number. This adaptation may become overwhelmed in the setting of superimposed renal insults, e.g. diabetes mellitus or rapid catch-up growth, leading to the vicious cycle of on-going hyperfiltration, proteinuria, nephron loss and progressive renal functional decline. Many millions of babies are born with low birth weight every year, and hypertension and renal disease prevalences are increasing around the globe. At present, little can be done clinically to augment nephron number; therefore adequate prenatal care and careful postnatal nutrition are crucial to optimize an individual’s nephron number during development and potentially to stem the tide of the growing cardiovascular and renal disease epidemics worldwide

Dynamics of glomerular ultrafiltration: VI. Studies in the primate

Dynamics of glomerular ultrafiltration: VI. Studies in the primate. Pressures and flows were measured in accessible surface glomeruli of the squirrel monkey under conditions of normal hydropenia. Mean glomerular capillary hydrostatic pressure and the mean glomerular transcapillary hydrostatic pressure difference (ΔP) averaged approximately 45 mm Hg and 35 mm Hg, respectively. These findings are in close accord with recent direct estimates in the rat. The net driving force for ultrafiltration was found to decline from a maximum value of about 12 mm Hg at the afferent end of the glomerular capillary network essentially to zero by the efferent end, indicating that, in the monkey as in the rat, filtration pressure equilibrium is achieved under normal hydropenic conditions. The monkey differs from the rat in one important respect, however, in that, as has long been recognized, the monkey tends to have higher systemic total plasma protein concentrations (CA) than the rat. This is of interest since monkey, like man, is found to have lower filtration fractions than the rat. Since ΔP is found to be essentially similar in monkey and rat, and since, at filtration pressure equilibrium, filtration fraction is determined by ΔP and CA, these observed differences in filtration fraction between rodent and primate must therefore be due to these differences in CA

Sensorimotor priors in non-stationary environments

In the course of its interaction with the world, the human nervous system must constantly estimate various variables in the surrounding environment. Past research indicates that environmental variables may be represented as probabilistic distributions of a priori information (priors). Priors for environmental variables that do not change much over time have been widely studied. Little is known however, about how priors develop in environments with non-stationary statistics. We examine whether humans change their reliance on the prior based on recent changes in environmental variance. Through experimentation, we obtain an online estimate of the human sensorimotor prior (prediction) and then compare it to similar online predictions made by various non-adaptive and adaptive models. Simulations show that models that rapidly adapt to non-stationary components in the environments predict the stimuli better than models that do not take the changing statistics of the environment into consideration. We found that adaptive models best predict participants' responses in most cases. However, we find no support for the idea that this is a consequence of increased reliance on recent experience just after the occurrence of a systematic change in the environment