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

Climate change and its influence in nephron mass

PURPOSE OF REVIEW The consequences of climate change, including heat and extreme weather events impact kidney function in adults and children. The impacts of climate change on kidney development during gestation and thereby on kidney function later in life have been poorly described. Clinical evidence is summarized to highlight possible associations between climate change and nephron mass. RECENT FINDINGS Pregnant women are vulnerable to the effects of climate change, being less able to thermoregulate, more sensitive to the effects of dehydration, and more susceptible to infections. Exposure to heat, wildfire smoke, drought, floods and climate-related infections are associated with low birth weight, preterm birth and preeclampsia. These factors are associated with reduced nephron numbers, kidney dysfunction and higher blood pressures in offspring in later life. Exposure to air pollution is associated with higher blood pressures in children and has variable effects on estimated glomerular filtration rate. SUMMARY Climate change has important impacts on pregnant women and their unborn children. Being born too small or too soon is associated with life-time risk of kidney disease. Climate change may therefore have a dual effect of impacting fetal kidney development and contributing to cumulative postnatal kidney injury. The impact on population kidney health of future generations may be significant

When the Earth trembles in the americas: the experience of haiti and chile 2010.

The response of the nephrological community to the Haiti and Chile earthquakes which occurred in the first months of 2010 is described. In Haiti, renal support was organized by the Renal Disaster Relief Task Force (RDRTF) of the International Society of Nephrology (ISN) in close collaboration with Médecins Sans Frontières (MSF), and covered both patients with acute kidney injury (AKI) and patients with chronic kidney disease (CKD). The majority of AKI patients (19/27) suffered from crush syndrome and recovered their kidney function. The remaining 8 patients with AKI showed acute-to-chronic renal failure with very low recovery rates. The intervention of the RDRTF-ISN involved 25 volunteers of 9 nationalities, lasted exactly 2 months, and was characterized by major organizational difficulties and problems to create awareness among other rescue teams regarding the availability of dialysis possibilities. Part of the Haitian patients with AKI reached the Dominican Republic (DR) and received their therapy there. The nephrological community in the DR was able to cope with this extra patient load. In both Haiti and the DR, dialysis treatment was able to be prevented in at least 40 patients by screening and adequate fluid administration. Since laboratory facilities were destroyed in Port-au-Prince and were thus lacking during the first weeks of the intervention, the use from the very beginning on of a point-of-care device (i-STAT®) was very efficient for the detection of aberrant kidney function and electrolyte parameters. In Chile, nephrological problems were essentially related to difficulties delivering dialysis treatment to CKD patients, due to the damage to several units. This necessitated the reallocation of patients and the adaptation of their schedules. The problems could be handled by the local nephrologists. These observations illustrate that local and international preparedness might be life-saving if renal problems occur in earthquake circumstances

Is competitive exclusion a valuable alternative for classical cleaning and disinfection of pig-growing units?

Colonization of the environment of pig-growing units by pathogenic microrganisms is an important factor in development of endemic diseases in pigs and, in spreading of zoonotic diseases. These pathogens are mostly controlled by the use of antibiotics and disinfection during vacancy. Because, the past years an increasing resistance against these measures is noticed, alternative methods such as competitive exclusion (CE) are promoted as promising. In this study the effect of a CE protocol on the bacterial infection in piggrowing units was compared to a classical cleaning and disinfection (C&D) protocol. Tests were performed during three successive production rounds using multiple identical pig-growing units. CE protocol consisted of cleaning (no disinfection) after loading piglets and spraying probiotic bacteria (Bacillus spp. spores) during vacancy and production. The cleaning product also contained Bacillus spores. Sampling was performed at different time-points: immediately after pig loading (manure still present); 24 hours after cleaning (CE units) or after disinfection (control units); after one week and five weeks of production (piglets present). At each time point, swab samples for analyses were taken. Enumerations of bacterial spores, Enterococcus spp., E. coli, fecal coliforms and MRSA and detections of E. coli, fecal coliforms and MRSA were performed. Next to bacterial analyses, also feed conversion and fecal consistency was monitored. This study showed that, although probiotic spores were administered well, the analyzed bacteria were not decreased after three production rounds in CE units and remained on the same level as the control units (C&D). Also, the infection pressure in CE units during vacancy was not as much reduced as after the disinfection-step in control units. Finally, no differences in feed conversion and fecal consistency were found. These results indicate that the used CE protocol is not a valuable alternative for classical C&D

The detection of acute risk of self-injury project:Protocol for an ecological momentary assessment study among individuals seeking treatment

Background:Nonsuicidal self-injury (NSSI) is a major mental health concern. Despite increased research efforts on establishing the prevalence and correlates of the presence and severity of NSSI, we still lack basic knowledge of the course, predictors, and relationship of NSSI with other self-damaging behaviors in daily life. Such information will be helpful for better informing mental health professionals and allocating treatment resources. The DAILY (Detection of Acute rIsk of seLf-injurY) project will address these gaps among individuals seeking treatment.Objective: This protocol paper presents the DAILY project's aims, design, and materials used. The primary objectives are to advance understanding of (1) the short-term course and contexts of elevated risk for NSSI thoughts, urges, and behavior; (2) the transition from NSSI thoughts and urges to NSSI behavior; and (3) the association of NSSI with disordered eating, substance use, and suicidal thoughts and behaviors. A secondary aim is to evaluate the perspectives of individuals seeking treatment and mental health professionals regarding the feasibility, scope, and utility of digital self-monitoring and interventions that target NSSI in daily life.Methods: The DAILY project is funded by the Research Foundation Flanders (Belgium). Data collection involves 3 phases: a baseline assessment (phase 1), 28 days of ecological momentary assessment (EMA) followed by a clinical session and feedback survey (phase 2), and 2 follow-up surveys and an optional interview (phase 3). The EMA protocol consists of regular EMA surveys (6 times per day), additional burst EMA surveys spaced at a higher frequency when experiencing intense NSSI urges (3 surveys within 30 minutes), and event registrations of NSSI behavior. The primary outcomes are NSSI thoughts, NSSI urges, self-efficacy to resist NSSI, and NSSI behavior, with disordered eating (restrictive eating, binge eating, and purging), substance use (binge drinking and smoking cannabis), and suicidal thoughts and behaviors surveyed as secondary outcomes. The assessed predictors include emotions, cognitions, contextual information, and social appraisals.Results: We will recruit approximately 120 individuals seeking treatment aged 15 to 39 years from mental health services across the Flanders region of Belgium. Recruitment began in June 2021 and data collection is anticipated to conclude in August 2023.Conclusions: The findings of the DAILY project will provide a detailed characterization of the short-term course and patterns of risk for NSSI and advance understanding of how, why, and when NSSI and other self-damaging behaviors unfold among individuals seeking treatment. This will inform clinical practice and provide the scientific building blocks for novel intervention approaches outside of the therapy room that support people who self-injure in real time

Community exposure and vulnerability to water quality and availability: a case study in the mining-affected Pazña Municipality, Lake Poopó Basin, Bolivian Altiplano

This is the final version of the article. Available from Springer Verlag via the DOI in this record.Assessing water sources for drinking and irrigation along with community vulnerability, especially in developing and rural regions, is important for reducing risk posed by poor water quality and limited water availability and accessibility. We present a case study of rural mining-agricultural communities in the Lake Poopó Basin, one of the poorest regions on the Bolivian Altiplano. Here, relatively low rainfall, high evaporation, salinization and unregulated mining activity have contributed to environmental degradation and water issues, which is a situation facing many Altiplano communities. Social data from 72 households and chemical water quality data from 27 surface water and groundwater sites obtained between August 2013 and July 2014 were used to develop locally relevant vulnerability assessment methodologies and ratings with respect to water availability and quality, and Chemical Water Quality Hazard Ratings to assess water quality status. Levels of natural and mining-related contamination in many waters (CWQHR ≥ 6; 78% of assessed sites) mean that effective remediation would be challenging and require substantial investment. Although waters of fair to good chemical quality (CWQHR ≤ 5; 22% of assessed sites) do exist, treatment may still be required depending on use, and access issues remain problematic. There is a need to comply with water quality legislation, improve and maintain basic water supply and storage infrastructure, build and operate water and wastewater treatment plants, and adequately and safely contain and treat mine waste. This study serves as a framework that could be used elsewhere for assessing and mitigating water contamination and availability affecting vulnerable populations.This project was funded by the University College London (UCL) Institute for Risk and Disaster Reduction and the Catholic Agency for Overseas Development (CAFOD) under the initiative of water risk and its management in Bolivia’s Altiplano development strategy, which was led by Stephen Edwards. The Natural Environment Research Council Probability, Uncertainty and Risk in the Environment grant PA13-010 (risk visualisation and quantification for enhanced disaster risk reduction) to Stephen Edwards informed the approach to and outputs from the project

Search for physics beyond the standard model in events with τ leptons, jets, and large transverse momentum imbalance in pp collisions at [Formula: see text].

A search for physics beyond the standard model is performed with events having one or more hadronically decaying τ leptons, highly energetic jets, and large transverse momentum imbalance. The data sample corresponds to an integrated luminosity of 4.98 fb-1 of proton-proton collisions at [Formula: see text] collected with the CMS detector at the LHC in 2011. The number of observed events is consistent with predictions for standard model processes. Lower limits on the mass of the gluino in supersymmetric models are determined

Search for supersymmetry in hadronic final states with missing transverse energy using the variables αT and b-quark multiplicity in pp collisions at [Formula: see text].

An inclusive search for supersymmetric processes that produce final states with jets and missing transverse energy is performed in pp collisions at a centre-of-mass energy of 8 TeV. The data sample corresponds to an integrated luminosity of 11.7 fb-1 collected by the CMS experiment at the LHC. In this search, a dimensionless kinematic variable, αT, is used to discriminate between events with genuine and misreconstructed missing transverse energy. The search is based on an examination of the number of reconstructed jets per event, the scalar sum of transverse energies of these jets, and the number of these jets identified as originating from bottom quarks. No significant excess of events over the standard model expectation is found. Exclusion limits are set in the parameter space of simplified models, with a special emphasis on both compressed-spectrum scenarios and direct or gluino-induced production of third-generation squarks. For the case of gluino-mediated squark production, gluino masses up to 950-1125 GeV are excluded depending on the assumed model. For the direct pair-production of squarks, masses up to 450 GeV are excluded for a single light first- or second-generation squark, increasing to 600 GeV for bottom squarks