Assessing the renal response in patients with potassium disorders: a shift in emphasis from the TTKG to the urine K+/creatinine ratio

This article briefly reviews the reasons for replacing the transtubular K+ gradient (TTKG) with the urine K+/creatinine ratio, as a tool for evaluating the response of the kidney in patients with potassium disorders. An appreciation of the magnitude and importance of the intrarenal recycling of urea led to the realization that a large amount of urea is reabsorbed daily in the terminal collecting duct and that this renders invalid the assumption, used by the TTKG, that there is minimal solute reabsorption downstream of the cortical collecting duct (CCD). The urine-to-plasma osmolality ratio can therefore not be used to calculate the volume of fluid exiting the CCD nor the concentration of K+ in the luminal fluid in this nephron segment. We now recommend the use of the K+/creatinine ratio in random urine samples to estimate the rate of K+ excretion. A ratio of less than 1.5 mmol K+/mmol creatinine would be expected if the kidney is responding appropriately to hypokalaemia from a non-renal cause, and a ratio greater than 20 mmol K+/mmol creatinine would be appropriate as the renal response to hyperkalaemia

Pathogenesis of distal renal tubular acidosis

Distal renal tubular acidosis (RTA) is a syndrome characterized by hyperchloremic metabolic acidosis and an inappropriately high urine pH relative to the degree of acidosis. The clinical presentation is frequently complicated by nephrocalcinosis, hypercalciuria, and nephrolithiasis. Less frequent presenting manifestations include hypokalemia and osteomalacia (for review of clinical features, see Refs. 1–4). Initially, all cases of renal tubular acidosis were considered to have similar pathophysiologic mechanisms, but subsequent studies have subdivided the group into abnormalities of bicarbonate reabsorption (proximal RTA), disorders of net acid excretion (distal or classical), and defects of ammonium production. In the present review, we will limit our discussion to the pathogenesis of distal RTA

Crystallization of a classical two-dimensional electron system: Positional and orientational orders

Crystallization of a classical two-dimensional one-component plasma (electrons interacting with the Coulomb repulsion in a uniform neutralizing positive background) is investigated with a molecular dynamics simulation. The positional and the orientational correlation functions are calculated for the first time. We have found an indication that the solid phase has a quasi-long-range (power-law) positional order along with a long-range orientational order. This indicates that, although the long-range Coulomb interaction is outside the scope of Mermin's theorem, the absence of ordinary crystalline order at finite temperatures applies to the electron system as well. The `hexatic' phase, which is predicted between the liquid and the solid phases by the Kosterlitz-Thouless-Halperin-Nelson-Young theory, is also discussed.Comment: 3 pages, 4 figures; Corrected typos; Double columne

Modulation of the secretion of potassium by accompanying anions in humans

Modulation of the secretion of potassium by accompanying anions in humans. In animals, secretion of potassium (K) in the cortical collecting duct (CCD) is modulated by the properties of the accompanying anion. In humans, results are inconclusive as previous studies have not differentiated between a kaliuresis due to a rise in the concentration of K from one due to an increase in the volume of urine. Our purpose was to study the effects of chloride (Cl) and bicarbonate on the secretion of K in the CCD in humans using the transtubular K concentration gradient (TTKG), a semi-quantitative index of secretion of K in the terminal CCD. After control blood and urine samples were obtained, all subjects ingested 0.2mg fludrocortisone to ensure that mineralocorticoids were not limiting the secretion of K. The anionic composition of the urine was varied using three protocols: Normal subjects (N = 11) ingested cystine and methionine to induce sulfaturia; nine subjects with a contracted ECF volume (to lower the concentration of Cl in the urine) were also studied during sulfaturia following the ingestion of cystine and methionine; 13 normovolemic subjects were studied during bicarbonaturia following the ingestion of acetazolamide. When the concentration of Cl in the urine was > 15 mmol/liter, sulfate had no effect on the TTKG. With lower concentrations of Cl in the urine, the TTKG rose 1.5-fold. The TTKG rose 1.8-fold in the presence of bicarbonaturia despite concentrations of Cl in the urine that were >15 mmol/liter, suggesting that bicarbonate has additional effects on this K secretory process. At comparable concentrations of sulfate and bicarbonate in the urine, the TTKG was increased only with bicarbonaturia. We conclude that it is important to control for the effects of the accompanying anions when evaluating the role of the kidney in disorders of K homeostasis

Melting of the classical bilayer Wigner crystal: influence of the lattice symmetry

The melting transition of the five different lattices of a bilayer crystal is studied using the Monte-Carlo technique. We found the surprising result that the square lattice has a substantial larger melting temperature as compared to the other lattice structures, which is a consequence of the specific topology of the temperature induced defects. A new melting criterion is formulated which we show to be universal for bilayers as well as for single layer crystals.Comment: 4 pages, 5 figures (postscript files). Accepted in Physical Review Letter

The Democratic Biopolitics of PrEP

PrEP (Pre-Exposure Prophylaxis) is a relatively new drug-based HIV prevention technique and an important means to lower the HIV risk of gay men who are especially vulnerable to HIV. From the perspective of biopolitics, PrEP inscribes itself in a larger trend of medicalization and the rise of pharmapower. This article reconstructs and evaluates contemporary literature on biopolitical theory as it applies to PrEP, by bringing it in a dialogue with a mapping of the political debate on PrEP. As PrEP changes sexual norms and subjectification, for example condom use and its meaning for gay subjectivity, it is highly contested. The article shows that the debate on PrEP can be best described with the concepts ‘sexual-somatic ethics’ and ‘democratic biopolitics’, which I develop based on the biopolitical approach of Nikolas Rose and Paul Rabinow. In contrast, interpretations of PrEP which are following governmentality studies or Italian Theory amount to either farfetched or trivial positions on PrEP, when seen in light of the political debate. Furthermore, the article is a contribution to the scholarship on gay subjectivity, highlighting how homophobia and homonormativity haunts gay sex even in liberal environments, and how PrEP can serve as an entry point for the destigmatization of gay sexuality and transformation of gay subjectivity. ‘Biopolitical democratization’ entails making explicit how medical technology and health care relates to sexual subjectification and ethics, to strengthen the voice of (potential) PrEP users in health politics, and to renegotiate the profit and power of Big Pharma

Enhanced stability of the square lattice of a classical bilayer Wigner crystal

The stability and melting transition of a single layer and a bilayer crystal consisting of charged particles interacting through a Coulomb or a screened Coulomb potential is studied using the Monte-Carlo technique. A new melting criterion is formulated which we show to be universal for bilayer as well as for single layer crystals in the case of (screened) Coulomb, Lennard--Jones and 1/r^{12} repulsive inter-particle interactions. The melting temperature for the five different lattice structures of the bilayer Wigner crystal is obtained, and a phase diagram is constructed as a function of the interlayer distance. We found the surprising result that the square lattice has a substantial larger melting temperature as compared to the other lattice structures. This is a consequence of the specific topology of the defects which are created with increasing temperature and which have a larger energy as compared to the defects in e.g. a hexagonal lattice.Comment: Accepted for publication in Physical Review

Meta-analysis of genome-wide association studies from the CHARGE consortium identifies common variants associated with carotid intima media thickness and plaque

Carotid intima media thickness (cIMT) and plaque determined by ultrasonography are established measures of subclinical atherosclerosis that each predicts future cardiovascular disease events. We conducted a meta-analysis of genome-wide association data in 31,211 participants of European ancestry from nine large studies in the setting of the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium. We then sought additional evidence to support our findings among 11,273 individuals using data from seven additional studies. In the combined meta-analysis, we identified three genomic regions associated with common carotid intima media thickness and two different regions associated with the presence of carotid plaque (P < 5 × 10 -8). The associated SNPs mapped in or near genes related to cellular signaling, lipid metabolism and blood pressure homeostasis, and two of the regions were associated with coronary artery disease (P < 0.006) in the Coronary Artery Disease Genome-Wide Replication and Meta-Analysis (CARDIoGRAM) consortium. Our findings may provide new insight into pathways leading to subclinical atherosclerosis and subsequent cardiovascular events

The effectiveness of bariatric surgery on long term psychosocial quality of life – A systematic review

© 2015 Asia Oceania Association for the Study of Obesity Background Little is known about the psychological effects of bariatric surgery. This review aimed to assess long term effectiveness of bariatric surgery on psychosocial quality of life (QoL) of obese adults compared to non-surgical interventions. Methods A systematic review of the literature was conducted, six electronic databases, plus other relevant sources were searched from inception to January 2014. The main outcome sought was a QoL measure with a minimum 12 months follow-up. Three reviewers screened records, extracted data and independently read through full articles for eligibility and quality using standardised forms. Findings were analysed using narrative synthesis. Results Of 4383 identified references included in the review, 11 studies showed bariatric surgery to be effective long term for overall QoL than non-surgical treatments with specifically modest benefits psychosocially. Significant improvements in psychosocial QoL alongside improved physical QoL were observed after 2 year follow-up post-surgery compared to non-surgical interventions. However improvements in psychosocial QoL after surgery at 10 year follow up were minimal when compared to non-surgical interventions. When compared to untreated control groups, long term psychosocial QoL did not improve after bariatric surgery despite major improvements in physical QoL, significant weight loss and co-morbidities. Conclusions Results on long term psychosocial QoL remain uncertain with some suggestion of psychological disorder persisting. This highlights need for psychological intervention post-surgery and further research to provide more data on long-term psychosocial QoL following bariatric surgery