The latest medical research on Kidney Cancer
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Associations of urinary and dietary sodium-to-potassium ratios with albuminuria in community-dwelling Japanese adults: a cross-sectional study.Kidney and Blood Pressure Research
The urinary sodium-to-potassium ratio is an indicator of dietary sodium intake and has been associated with reduced kidney function. However, less is known about its association with albuminuria, the other key component of chronic kidney disease, in the community-dwelling adult population. We examined the association of the spot urinary sodium-to-potassium ratio with albuminuria and compared spot urinary and dietary sodium-to-potassium ratios.
We quantified the association of the urinary sodium-to-potassium ratio with albuminuria in 6,274 Japanese adults (age, 40-97 years; 50.9% women) based on spot urine samples. We performed linear and logistic regression modeling to account for potential confounders. Elevated albuminuria was defined as a spot urinary albumin-to-creatinine ratio (ACR) ≥ 30 mg/g. We secondarily evaluated the dietary sodium-to-potassium ratio based on a food-frequency questionnaire.
The median spot urinary and dietary sodium-to-potassium ratios were 2.70 (interquartile interval, 1.87-3.83) and 1.50 (1.21-1.84), respectively. The median ACR was 11.0 (6.0-24.0) mg/g. In a multivariable linear regression model, the spot urinary sodium-to-potassium ratio (per increment) was significantly associated with the natural logarithm of the ACR (regression coefficient, 0.023 [95% confidence interval [95% CI], 0.007-0.038]). This result was consistent in a multivariable logistic regression model (adjusted odds ratio, 1.08 [95% CI, 1.04-1.12]). The corresponding estimates for the dietary sodium-to-potassium ratio were 0.139 (95% CI, 0.087-0.191) and 1.28 (95% CI, 1.14-1.45), respectively.
Both spot urinary and dietary sodium-to-potassium ratios were associated with elevated albuminuria in community-dwelling Japanese adults. Our findings further support the potential usefulness of the spot urinary sodium-to-potassium ratio as an indicator of sodium intake and suggest a link between sodium intake and kidney damage.
Identification of hub gene and transcription factor related to chronic allograft nephropathy based on WGCNA analysis.Kidney and Blood Pressure Research
Introduction Kidney transplantation has surpassed dialysis as the optimal therapy for end-stage kidney disease (ESKD). Yet, most patients could suf...
Bioelectrical impedance vector analysis and brain natriuretic peptide in the evaluation of patients with chronic kidney disease in hemodialitic treatment.Kidney and Blood Pressure Research
Setting dry weight (DW) in haemodialysis (HD) patients is still an hard issue. Several clinical, haematochimical and instrumental parameters have been considered. In the last years bioelectrical impedance vector analysis (BIVA) became the main method to evaluate body composition and water body percentage. However it is still difficult to assess the nutritional status and identify a correct DW in HD patients.
to set DW and nutritional status, combining BIVA with phase angle (PhA) and serum brain natriuretic peptide (BNP) in HD patients.
we evaluated PhA and BNP modifications before (T0), after HD section (T1) and after 60 days (T2), in all patients treated in our HD centre.
A total of 50 patients (36 males) with a mean age of 70.1 ± 8.85 years, were recruited. We did not report significant changes in BNP and PhA between T0 and T1, while they were significantly different between T0 and T2. We also reported a significant difference between T0 and T2 in ECW / TBW, while we did not show significant variations in ECM / BMC between T0, T1 and T2 indicating a stability of the nutritional status. PhA, BNP and ECW / TBW, returned to a normal value in patients in which we reached a DW, also considering clinical parameters such as blood pressure and antihypertensive therapy. The weight loss obtained with the evaluation of the BIVA and the BNP was 1.2-5.7 kg, greater than that calculated empirically which stood at around 0.9-4.3 Kg.
We suggest to carry out BIVA with PhA combined with BNP to assess an adequate DW and evaluate a correct nutritional status in HD patients.
How the availability of anti-C5a agents could change the management of ANCA-associated Vasculitis.Kidney and Blood Pressure Research
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a cluster of potentially life-threatening disorders often involving the kidney with a necrotizing crescentic glomerulonephritis with scanty deposition of immunoglobulins and complement. Historically the role of complement has been considered ancillary. Recently, an anti-myeloperoxidase (MPO) AAV model in complement-deficient mice has shown an involvement for the complement cascade in the development of the renal injuries. Further animal studies showing that in contrast to mice deficient for factor B and C5 animals deficient for C4 were susceptible to AAV development by injection of anti-MPO antibodies emphasized the specific involvement of the alternative pathway. Consonantly, the C5a receptor (Cd88) blockade was found to protect mice from MPO AAV. CCX168, i.e., Avacopan, a powerful inhibitor of C5a receptor that can be administered orally, was shown to reduce the pro-inflammatory effects of C5a and abolish the activation of neutrophils, their migration and adherence to endothelium, and the vascular endothelial cell retraction that increases permeability.
The results of the ADVOCATE trial opened new prospects for the treatment of AAV and also other immune-mediated diseases with renal involvement. The possible position of Avacopan in a routinary clinical setting and its possible indications in specific subsets of patients with AAV are extensively discussed.
Effect of high-dose glucocorticoids on markers of inflammation and bone metabolism in patients with primary glomerular disease.Kidney and Blood Pressure Research
Glucocorticoids are one of the most commonly used drugs for treatment of inflammatory and autoimmune diseases. Sirtuin-1 (SIRT-1) belongs to family of proteins involved in protection against inflammation and oxidative stress. A role of SIRT-1 in regulation of bone metabolism during high-dose steroid therapy is unknown.
The study assessed influence of high doses of intravenous corticosteroids on plasma inflammation and bone markers in patients with primary glomerular disease.
The study included 40 patients (25 M, 15 F; mean age 53.1±14 years) with chronic kidney disease (mean estimated glomerular filtration rate (eGFR) 58.9±31.3 ml/min). The main inclusion criterion was clinical and histopathological diagnosis of primary glomerular disease and urine protein excretion >2.0 g/24h. The patients received intravenous pulses of methylprednisolone 20-30 mg/kg/day for three consecutive days followed by oral prednisone 0.8-1.0 mg/kg/day. The blood was taken before administration of methylprednisolone to assess plasma SIRT-1, sclerostin, calcium, phosphate and parathormone (PTH) and first morning urine sample was taken for measurement of calcium, phosphate and albumin to creatinine ratio. The same laboratory tests were repeated after 4, 7 and 30 days during steroid therapy.
Plasma SIRT-1 increased significantly during steroid administration. Plasma sclerostin did not change significantly. There was a significant linear negative correlation between changes of SIRT-1 levels and sclerostin throughout the study. In a multiple regression model changes of plasma sclerostin induced by steroid therapy explained the largest part of variance of respective changes of plasma SIRT-1.
Plasma SIRT-1 increase during high-dose corticosteroid therapy is negatively related to the change of plasma sclerostin that may suggest a protective role of SIRT-1 against the negative effects of steroid therapy on bone. .
Improvement in Kidney Function After Discontinuation of Fenofibrate in Outpatient Nephrology Consultation for Chronic Kidney Disease.Kidney and Blood Pressure Research
It has been noted in observational and interventional studies that individuals exposed to fenofibrate can exhibit a rise in serum creatinine (sCr) concentration. However, it is not known to what extent this phenomenon impacts kidney function in patients who are referred to a nephrology clinic for consultation for chronic kidney disease (CKD).
We conducted a prospective observational study of patients referred to our nephrology clinic for a new evaluation of a rise in sCr or worsening CKD and who were on fenofibrate therapy. We examined the effect of discontinuation of fenofibrate on kidney function, change in sCr and estimated glomerular filtration (eGFR) at 3, 6 and 12 months.
A total of 22 patients (59% women, 86% white, 59% with type 2 diabetes, 18% with peripheral arterial disease) were captured over 2.5 years. Median sCr at the time of fenofibrate discontinuation was 1.9 (1.1-3.3) mg/dL and eGFR 32 (17-57) ml/min; proteinuria was absent in 17 (77%). Upon discontinuation of fenofibrate, median sCr decreased to 1.5 (0.9-2.4), 1.4 (1.0-2.5) and 1.4 (1.0-2.3) mg/dL at 3, 6, and 12 months respectively (p<0.05); whereas median eGFR increased to 44 (27-71), 45 (23-71) and 42 (21-71) ml/min respectively (p<0.05). A ≥30% rise in eGFR was observed in 59% of the patients at 3 months and it persisted in 45% and 50% of patients at 6 and 12 months, respectively.
Discontinuation of fenofibrate in patients referred for CKD evaluation can result in sustained reduction in sCr in about half of the patients and for up to 1 year. There is a need to raise awareness among primary practitioners about this phenomenon. Recognition of fenofibrate as a cause of rise in sCr could reduce unnecessary nephrology consultation and resource utilization.
The correlation between ferroptosis and m6A methylation in patients with acute kidney injury.Kidney and Blood Pressure Research
The present research analyzed the correlation between m6A methylation and ferroptosis associated genes (FAGs) in acute kidney injury (AKI) patients.
Bioinformatics analysis of microarray profiles (GSE30718) were performed to select differential expression genes (DEGs). FAGs are derived from systematic analysis of the aberrances and functional implications. The m6A methylation related genes were derived from the molecular characterization and clinical significance of m6A modulators. The multi-gene correlation of ferroptosis and M6A methylation modification were displayed. Then, the CIBERSORT algorithm was used to analyse the proportions of 22 immune cells infiltration.
In total, 349 DEGs were extracted between the AKI and control samples, among which 172 genes were up-regulated and 177 were down-regulated. FAGs (SLC1A5, CARS, SAT1, ACSL4, NFE2L2, TFRC and MT1G) and m6A methylation related genes (YTHDF3, WTAP and IGF2BP3) were significantly increased in AKI patients (P< 0.05). FAGs (SAT1, ACSL4 and NFE2L2) was positively correlated with the expression level of m6A methylation genes (P< 0.05). NFE2L2 has high diagnostic value, and level of NFE2L2 was negatively correlated with the degree of follicular helper T (TFH) cells infiltration.
Our research could provide a new theoretical basis for the pathogenesis and immune mechanism of AKI.
Physical Activity in Renal Disease (PAIRED) and the effect on hypertension: a randomized controlled trial.Kidney and Blood Pressure Research
Exercise is an effective strategy for blood pressure (BP) reduction in the general population, but efficacy for the management of hypertension in CKD is not known. We evaluated the difference in 24-hour ambulatory systolic BP with exercise training in people with moderate to severe chronic kidney disease (CKD).
Participants with an estimated glomerular filtration rate (eGFR) of 15-44 mL/min per 1.73m2 and SBP >120 mmHg were randomized to receive thrice weekly, moderate intensity aerobic-based exercise over 24 weeks, or usual care. Phase 1 included supervised in-center and home-based sessions for eight weeks. Phase 2 was 16 weeks of home-based sessions. BP, arterial stiffness, cardiorespiratory fitness, and markers of CV risk were analyzed using mixed linear regression.
We randomized 44 people; 36% were female, median age was 69 years, 55% had diabetes and the median eGFR was 28 mL/min per 1.73m2. Compared with usual care, there was no significant change in 24-ambulatory SBP at eight weeks 2.96 mmHg (95% CI -2.56, 8.49) or 24 weeks. Peak oxygen uptake improved by 1.9 mL/kg/min in the exercise group (95% CI 0.03, 3.79) at eight weeks with a trend toward higher BMI 1.84 kg/m2 (95% CI -0.10, 3.78) and fat free mass, but this was not sustained at 24 weeks. Markers of CV risk were unchanged.
Despite an improvement in VO2peak and body composition, we did not detect a change in 24-hour ambulatory systolic BP in people with moderate to severe chronic kidney disease.
Cognitive impairment and kidney transplantation- underestimated, underrecognized but clinically relevant problem.Kidney and Blood Pressure Research
Chronic kidney disease (CKD) affects the crosstalk between organs in the body and vast majority of studies were devoted to the interactions between the kidneys and the cardiovascular system. As of today, there is more evidence of the kidney and the central nervous system connections.
• Cognitive impairment in kidney transplant recipients is underestimated, underrecognized but clinically relevant problem. • The screening for cognitive declines after kidney transplantation is not yet a routine practice. • Several prospective and cross-sectional studies reported improvement across some of the assessed cognitive domains after transplantation.
Specific alterations of Gut microbiota in Chinese patients with Hypertension: A systematic review and meta-analysis.Kidney and Blood Pressure Research
China has the largest absolute burden of hypertension (HTN) in the world. Gut dysbiosis may be a potentially modifiable risk factor for HTN. However, the characteristics of gut microbiota in Chinese populations with HTN remain to be determined.
We systematically searched for studies comparing the gut microbial in HTN with healthy controls in databases. The cut-off date was December 30, 2021. Semiquantitative analysis and meta-analysis with standardized mean differences of the alteration in gut microbiota were carried out.
A total of 16 studies involving 2372 patients with HTN and 849 controls were included, covering 16 Chinese provinces or regions. The present study supports that compared to healthy population, the diversity of patients with HTN is significantly compromised, while richness is overall preserved. To be specific, a significant increase of the Firmicutes(F)/Bacteroidetes(B) ratio is considered as a special parameter of gut microbiota in HTN patients. The increased abundance of phylum Firmicutes, genus Megasphaera, Escherichia_Shigella, and Klebsiella, while the lower abundance of phylum Bacteroidetes, genus Bifidobacterium, Faecalibacterium, Roseburia, and Ruminococcus may be associated with HTN. The gut microbial metabolism in HTN was more abundant in LPS biosynthesis, membrane transport, and steroid degradation.
Variation in gut microbial parameters is likely associated with Chinese patients with HTN. Further investigations should distinguish geographical and ethnic characteristics to develop in-depth knowledge of the underlying mechanisms by which gut dysbiosis contributes to HTN.
Intravascular Renal Denervation Reduces Ambulatory and Office Blood Pressure in Patients with Essential Hypertension: A Meta-Analysis of Randomized Sham-Controlled Trials.Kidney and Blood Pressure Research
This meta-analysis was designed to evaluate the antihypertensive efficacy of intravascular renal denervation (RDN) in patients with essential hypertension, especially to determine the magnitude of blood pressure (BP) reduction with RDN therapy using second-generation catheters.
PubMed was searched to identify randomized sham-controlled trials from inception through August 2021. The endpoints were changes in 24-hours (24-h) ambulatory BP or office BP (OBP). This meta-analysis was performed by calculating the weighted mean difference (WMD) with 95% confidence interval (CI) using the random-effects model when the I2 index was < 50%. Fixed-effects model was used when the I2 index was ≥ 50%.
A total of 1297 patients were included in 8 randomized, sham-controlled trials in this meta-analysis. Intravascular RDN reduced 24-h ambulatory systolic BP (SBP) -3.02 (WMD, 95% CI, -4.95, -1.10, p <0.01,) and diastolic BP (DBP) -1.66 (WMD, 95% CI, -2.44, -0.88, p<0.001) mm Hg, respectively. In the studies using first-generation catheters, the WMD of 24-h ambulatory SBP and DBP changes between intravascular RDN and sham-control were -2.67 (95% CI, -5.08, -0.27; P<0.05) and -0.82 (95% CI, -2.19, 0.56; P>0.05) mm Hg. In the studies using second-generation catheters, the WMD of 24-h ambulatory SBP and DBP changes between intravascular RDN and sham-control were -3.14 (95% CI, -5.94, -0.33, p<0.05) and -2.06 (95% CI, -3.02, -1.11, p<0.001) mm Hg. Intravascular RDN using second-generation catheters reduced office SBP -6.30 (WMD, 95% CI, -7.67, -4.93, p<0.001) and DBP -3.88 (WMD, 95% CI, -4.44, -3.33, p<0.001) mm Hg, respectively.
Intravascular RDN using second-generation catheters reduces ambulatory and office BP in patients with essential hypertension. The selection of appropriate hypertensive patients may be the major challenge for the performance of intravascular RDN in routine clinical practice.
The dopamine system: insights between kidney and brain.Kidney and Blood Pressure Research
Chronic kidney disease (CKD) is one of the most common diseases in adult age and it is typical of older adults. Recent data suggest that almost half of the elders have CKD. It is now clear that CKD is accompanied, in the early stages, by cognitive impairment, together with depression and subtle abnormalities in motor control (such as gait and balance alterations).
Several observations suggest a limited relevance of the dopaminergic system in CKD-related cognitive impairment. However, a common sleep disturbance in CKD, the restless leg syndrome, improves with dopaminergic drugs. Therefore, it remains to be established the role of the dopamine system in subtle motor dysfunction observed in CKD, such as tremors, gait alterations, and central sleep apnea.