Jean-Martin Charcot - Neurologist by Avocation, Nephrologist by Yearning

In an age of medical advances and specialization, Jean-Martin Charcot (1825-1893) helped found the discipline of neurology and in 1882 was appointed the first professor of Diseases of the Nervous System in France. As an investigator with broad interests and vast knowledge Charcot contributed to several other disciplines. An early mentor and dominant figure in Charcot\u27s formative years was Pierre Rayer (1793-1867), famous for his seminal contributions to the study of the kidney, who gifted Charcot with his passion for clinical pathological correlations and likely a yearning for the study of kidney diseases. Famous for the clarity and incisiveness of his formal teaching presentations, Charcot lectured on the kidney at the Faculty of Medicine in Paris in 1877. Translated into English and published as a book titled Lectures on Bright\u27s Disease, they became widely accessible and quoted in the literature through the present. In addition, at a time that he was already concentrating on the study of neurological disorders, Charcot maintained his life-long interest in the kidney and published original studies on the pathological changes of the kidney in gout and experimental lead poisoning, as well as supporting a study of hysterical ischuria by his students

Statistical Properties of Height of Japanese Schoolchildren

We study height distributions of Japanese schoolchildren based on the statictical data which are obtained from the school health survey by the ministry of education, culture, sports, science and technology, Japan . From our analysis, it has been clarified that the distribution of height changes from the lognormal distribution to the normal distribution in the periods of puberty.Comment: 2 pages, 2 figures, submitted to J. Phys. Soc. Jpn.; resubmitted to J. Phys. Soc. Jpn. after some revisio

Decreased phosphate reabsorption by volume expansion in the dog

Decreased phosphate reabsorption by volume expansion in the dog. The effect of volume expansion on tubular phosphate reabsorption (TRP) was studied in intact and acutely thyroparathyroidectomized (TPTX) dogs infused with a neutral phosphate solution. The infusion of a Ca++-containing balanced electrolyte solution increased CNa × 100/GFR from 0.23 to 6.87% and reduced TRP × 100/GFR from 6.2 to 3.6 mg/min in the intact dogs; in TPTX dogs these values changed from 0.35 to 7.02% and from 6.7 to 4.6 mg/min, respectively. Ultrafilterable Ca++ did not fall in either group. When Ca++ was omitted from the loading electrolyte solution ultrafilterable Ca++ fell significantly in both groups. In the intact dogs CNa × 100/GFR increased from 0.48 to 6.26% and TRP × 100/GFR fell from 4.5 to 2.8 mg/min; in TPTX dogs these values changed from 0.48 to 8.26% and from 6.5 to 4.1 mg/min. Thus volume loading appears to inhibit TRP regardless of the presence or absence of parathyroid hormone, and whether dilutional hypocalcemia was prevented or not. It is concluded that the previously reported blunting of the phosphaturic effect of volume expansion by acute parathyroidectomy or calcium infusion may have been due to a low serum phosphorus or filtered phosphate load relative to an increased threshold or tubular reabsorptive maximum or decreased splay

The best dialysis therapy? Results from an international survey among nephrology professionals

Background. There is little evidence for superior outcome of one dialysis therapy versus another. Still, nephrologists have to prescribe dialysis every day. It is therefore of interest to ascertain the opinion among nephrology professionals regarding which therapy they consider to be the best and to compare this to reality

The obesity paradox in chronic disease: facts and numbers

Body size, particularly large, is a matter of concern among the lay public. Whether this is justified depends upon the state of health and should be judged individually. For patients with established chronic disease, there is sufficient evidence to support the benefits of large body size, i.e., the obesity paradox. This uniform finding is shared over a variety of cardiovascular, pulmonary, and renal diseases and is counterintuitive to the current concepts on ideal body weight. The scientific community has to increase the awareness about differences for optimal body size in health and disease. Simultaneously, clinicians have to be aware about body weight dynamics implications and should interpret the changes in the context of an underlying disease in order to implement the best available management

Effect of a reduction in glomerular filtration rate after nephrectomy on arterial stiffness and central hemodynamics: rationale and design of the EARNEST study

Background: There is strong evidence of an association between chronic kidney disease (CKD) and cardiovascular disease. To date, however, proof that a reduction in glomerular filtration rate (GFR) is a causative factor in cardiovascular disease is lacking. Kidney donors comprise a highly screened population without risk factors such as diabetes and inflammation, which invariably confound the association between CKD and cardiovascular disease. There is strong evidence that increased arterial stiffness and left ventricular hypertrophy and fibrosis, rather than atherosclerotic disease, mediate the adverse cardiovascular effects of CKD. The expanding practice of live kidney donation provides a unique opportunity to study the cardiovascular effects of an isolated reduction in GFR in a prospective fashion. At the same time, the proposed study will address ongoing safety concerns that persist because most longitudinal outcome studies have been undertaken at single centers and compared donor cohorts with an inappropriately selected control group.<p></p> Hypotheses: The reduction in GFR accompanying uninephrectomy causes (1) a pressure-independent increase in aortic stiffness (aortic pulse wave velocity) and (2) an increase in peripheral and central blood pressure.<p></p> Methods: This is a prospective, multicenter, longitudinal, parallel group study of 440 living kidney donors and 440 healthy controls. All controls will be eligible for living kidney donation using current UK transplant criteria. Investigations will be performed at baseline and repeated at 12 months in the first instance. These include measurement of arterial stiffness using applanation tonometry to determine pulse wave velocity and pulse wave analysis, office blood pressure, 24-hour ambulatory blood pressure monitoring, and a series of biomarkers for cardiovascular and bone mineral disease.<p></p> Conclusions: These data will prove valuable by characterizing the direction of causality between cardiovascular and renal disease. This should help inform whether targeting reduced GFR alongside more traditional cardiovascular risk factors is warranted. In addition, this study will contribute important safety data on living kidney donors by providing a longitudinal assessment of well-validated surrogate markers of cardiovascular disease, namely, blood pressure and arterial stiffness. If any adverse effects are detected, these may be potentially reversed with the early introduction of targeted therapy. This should ensure that kidney donors do not come to long-term harm and thereby preserve the ongoing expansion of the living donor transplant program.<p></p&gt

Fracture Risk Assessment in Chronic Kidney Disease, Prospective Testing Under Real World Environments (FRACTURE): a prospective study

<p>Abstract</p> <p>Background</p> <p>Chronic kidney disease (CKD) is associated with an increased risk of fracture. Decreased bone mass and disruption of microarchitecture occur early in the course of CKD and worsens with the progressive decline in renal function so that at the time of initiation of dialysis at least 50% of patients have had a fracture. Despite the excess fracture risk, and the associated increases in morbidity and mortality, little is known about the factors that are associated with an increase in fracture risk. Our study aims to identify prognostic factors for bone loss and fractures in patients with stages 3 to 5 CKD.</p> <p>Methods</p> <p>This prospective study aims to enroll two hundred and sixty men and women with stages 3 to 5 CKD. Subjects will be followed for 24 months and we will examine the ability of: 1) bone mineral density by dual x-ray absorptiometry at the spine, hip, and radius; 2) volumetric bone density by high resolution peripheral quantitated computed tomography at the radius and tibia; 3) serum markers of bone turnover; 4) bone formation rate by bone biopsy; and 5) muscle strength and balance to predict spine and non-spine fractures, identified by self-report and/or vertebral morphometry. All measurements will be obtained at baseline, at 12 and at 24 months with the exception of bone biopsy, which will be measured once at 12 months. Subjects will be contacted every 4 months to determine if there have been incident fractures or falls.</p> <p>Discussion</p> <p>This study is one of the first that aims to identify risk factors for fracture in early stage CKD patients. Ultimately, by identifying risk factors for fracture and targeting treatments in this group-before the initiation of renal replacement therapy - we will reduce the burden of disease due to fractures among patients with CKD.</p