Gestational Diabetes Type 2: Variation in High-Density Lipoproteins Composition and Function

Aims: Class A2 gestational diabetes mellitus (GDMA2) has short- and long-term effects on the mother and child. These may include abnormalities of placentation, damage to endothelial cells and cardiovascular disease. This research investigated the function and composition of high-density lipoproteins (HDL) among women with GDMA2 and their fetuses. Methods: Thirty pregnant women were recruited during admission for delivery. The function and expression of HDL, paraoxonase1 (PON1) and apolipoprotein A1 (APOA1) in the blood samples and the placental tissue were evaluated. The effect of HDL on migration of endothelial cells was measured in vitro. Results: Compared to normal pregnancy (NP), APOA1 in the maternal plasma of women with GDMA2 was decreased. More APOA1 and PON1 were released from HDL of women with GDMA2, compared to NP. Placental APOA1 and PON1 were decreased in GDMA2. For endothelial cells stimulated with TNFα, HDL cell migration was decreased when cells were evaluated with NP-HDL, as compared to GDMA2-HDL. Conclusions: GDMA2 affects the composition and function of HDL in plasma. Changes in HDL commonly seen in GDMA2 were observed in maternal and placental samples, but not in cord samples. These results might indicate a placental role in protecting the fetus by preserving the components and functions of HDL and require further investigation

Acute kidney injury and rehabilitation outcomes among elderly patients with chronic kidney disease

Introduction: As the geriatric population rapidly grows, so does the incidence of chronic kidney disease (CKD). CKD patients have higher incidence of fractures, stroke and hospitalizations requiring rehabilitation along with the need for suitable rehabilitation programs to decrease disability and improve functionality to maintain independence in activities of daily life of elderly CKD patients. Considering that survivors of acute kidney injury (AKI) tend to experience decreased quality of life with aggravating frailty, rehabilitation in the elderly with kidney injury becomes even more complex. The aim of this study was to Examine the impact of AKI on the outcomes of rehabilitation among elderly patients with CKD. Methods: For this retrospective, observational study, the electronic medical records of all patients who were hospitalized in the Rehabilitation Department were reviewed. We assessed functional status at the beginning and at the end of rehabilitation, renal outcome and all-cause mortality among elderly patients with CKD who had AKI and compared to those who did not have AKI. Results: The study cohort included 183 elderly patients with non-dialysis dependent CKD. Patients with AKI had a higher prevalence of heart failure and lower baseline estimated GFR, as compared with patients who did not have AKI. They were admitted to rehabilitation at worse functional capacity and were also discharged with lower FIM scores. Overall OR for all-cause death among AKI versus non-AKI patients was 3.2 (95%CI: 1.6-6.5; p=0.001). Conclusion: AKI and CKD are interconnected syndromes that associate with worse rehabilitation outcomes and mortality among elderly patients

Proximal tubular hypertrophy and enlarged glomerular and proximal tubular urinary space in obese subjects with proteinuria.

BACKGROUND: Obesity is associated with glomerular hyperfiltration, increased proximal tubular sodium reabsorption, glomerular enlargement and renal hypertrophy. A single experimental study reported an increased glomerular urinary space in obese dogs. Whether proximal tubular volume is increased in obese subjects and whether their glomerular and tubular urinary spaces are enlarged is unknown. OBJECTIVE: To determine whether proximal tubules and glomerular and tubular urinary space are enlarged in obese subjects with proteinuria and glomerular hyperfiltration. METHODS: Kidney biopsies from 11 non-diabetic obese with proteinuria and 14 non-diabetic lean patients with a creatinine clearance above 50 ml/min and with mild or no interstitial fibrosis were retrospectively analyzed using morphometric methods. The cross-sectional area of the proximal tubular epithelium and lumen, the volume of the glomerular tuft and of Bowman's space and the nuclei number per tubular profile were estimated. RESULTS: Creatinine clearance was higher in the obese than in the lean group (P=0.03). Proteinuria was similarly increased in both groups. Compared to the lean group, the obese group displayed a 104% higher glomerular tuft volume (P=0.001), a 94% higher Bowman's space volume (P=0.003), a 33% higher cross-sectional area of the proximal tubular epithelium (P=0.02) and a 54% higher cross-sectional area of the proximal tubular lumen (P=0.01). The nuclei number per proximal tubular profile was similar in both groups, suggesting that the increase in tubular volume is due to hypertrophy and not to hyperplasia. CONCLUSIONS: Obesity-related glomerular hyperfiltration is associated with proximal tubular epithelial hypertrophy and increased glomerular and tubular urinary space volume in subjects with proteinuria. The expanded glomerular and urinary space is probably a direct consequence of glomerular hyperfiltration. These effects may be involved in the pathogenesis of obesity-related renal disease

Humoral Response to Hepatitis B and COVID-19 Vaccine among Maintenance Hemodialysis Patients

Maintenance hemodialysis (MHD) patients have impaired immunological responses to pathogens and vaccines. In this study, we compared the humoral response to HBV and COVID-19 vaccines in a cohort of MHD patients. Demographic and clinical characteristics of vaccine responders and non-responders were also compared, and the association between the humoral responses to both vaccines was evaluated. The cohort included 94 MHD patients who were vaccinated at least once for HBV and twice for COVID-19. Among the 94 patients, 28 (29.8%) did not develop protective titers to HBV. Hypertension, coronary heart disease, and heart failure were more common in non-responders. Among MHD patients, 85% had positive IgG anti-spike SARS-CoV-2 levels 6 months after two doses of BNT162b2 (Pfizer/Biotech) vaccine. Age and immunosuppressive therapy were the main predictors of humoral response to COVID-19 vaccine. We did not find any association between non-responders to HBV and non-responders to COVID-19 vaccine. There was no difference in IgG anti-spike titers between HBV responders and non-responders (505 ± 644 vs. 504 ± 781, p = 0.9) Our results suggest that reduced humoral response to hepatitis B is not associated with reduced response to COVID-19 vaccine. Different risk-factors were associated with poor immune response to HBV and to COVID-19 vaccines

Distribution frequency of the glomerular tuft cross-sectional area (a) and Bowman’s space cross-sectional area (b) in lean and obese subjects.

<p>Distribution frequency of the glomerular tuft cross-sectional area (a) and Bowman’s space cross-sectional area (b) in lean and obese subjects.</p

Glomerular Tuft and Bowman’s Space Cross Sectional Area in Lean and Obese Subjects.

<div><p>Figure 1a & 1b: The cross sectional area of the glomerular tuft area is larger in the obese than in the lean subjects (original magnification x200). (a) Lean subject: the cross sectional area of this glomerular tuft (dotted arrow) is 15,460 μ² (mean cross sectional area of the lean group: 15,800 μ²). (b) Obese subject: the cross sectional area of this glomerular tuft (arrow) is 24,730 μ² (mean cross sectional area of the obese group: 25,500 μ²).</p> <p>Figure 1c & 1d: The cross sectional area of Bowman’s space is larger in the obese than in the lean subjects (original magnification x200). (c) Lean subject: the area of this Bowman’s space cross section (dotted arrow) is 3090 μ² (mean cross sectional area of the lean group: 3400 μ²). (d) Obese subject: the area of this Bowman’s space cross section (arrow) is 4640 μ² (mean cross sectional area of the obese group: 4800 μ²).</p></div

Proximal Tubular Epithelium and Tubular Lumen Cross Sectional Area in Lean and Obese Subjects.

<div><p>Figure 2 a & b: The cross sectional area of the proximal tubular epithelium is larger in the obese than in the lean subjects (original magnification x400). (a) Lean subject: the cross sectional area of this proximal tubular epithelium (dotted arrow) is 2995 μ² (mean cross sectional area of the lean group: 2980 μ²). (b) Obese subject: the cross sectional area of this proximal tubular epithelium (arrow) is 4060 μ² (mean cross sectional area of the obese group: 3950 μ²).</p> <p>Figure 2 c & d: The cross sectional area of the proximal tubular lumen is larger in the obese than in the lean subjects (original magnification x400). (c) Lean subject: the cross sectional area of this proximal tubular lumen (dotted arrow) is 970 μ² (mean cross sectional area of the lean group: 960 μ²). (d) Obese subject: the cross sectional area of this proximal tubular lumen (arrow) is 1550 μ² (mean cross sectional area of the obese group: 1480 μ²).</p></div