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Kazawa M, Kabata D, Yoshida H, Minami K, Maeda T, Yoshitani K, Matsuda H, Shintani A. Amino acids to prevent cardiac surgery-associated acute kidney injury: a randomized controlled trial. JA Clin Rep 2024; 10:19. [PMID: 38528235 DOI: 10.1186/s40981-024-00703-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND This study aimed to examine the preventive effect of amino acids on postoperative acute kidney injury (AKI). METHODS This was single-center, patient- and assessor-blinded, randomized controlled trial. Patients who underwent aortic surgery with cardiopulmonary bypass were included. The intervention group received 60 g/day of amino acids for up to 3 days. The control group received standard care. The primary outcome was the incidence of AKI. We assessed the effect of amino acids on AKI using a Cox proportional hazards regression model. RESULTS Sixty-six patients were randomly assigned to the control or intervention group. One patient in the control group withdrew consent after randomization. The incidence of AKI was 10 patients (30.3%) in the intervention group versus 18 patients (56.2%) in the control group (adjusted hazard ratio, 0.44; 95% confidence interval, 0.20-0.95; P = 0.04). CONCLUSIONS This trial demonstrated a significant reduction in AKI incidence with amino acid supplementation. TRIAL REGISTRATION jRCT, jRCTs051210154. Registered 31 December 2021, https://jrct.niph.go.jp/re/reports/detail/69916.
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Affiliation(s)
- Masahiro Kazawa
- Department of Critical Care Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shinmachi, Suita, Osaka, Japan.
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
| | - Daijiro Kabata
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hisako Yoshida
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kimito Minami
- Department of Critical Care Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shinmachi, Suita, Osaka, Japan
| | - Takuma Maeda
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kenji Yoshitani
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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Brusasco C, Valenzi FM, Micali M, Ennas M, Di Domenico A, Germinale F, Dotta F, Benelli A, Campodonico F, Cucciolini G, Carbone A, Introini C, Corradi F. Perioperative Intravenous Amino Acid Infusion in Major Urologic Surgery. J Clin Med 2023; 12:6614. [PMID: 37892752 PMCID: PMC10607134 DOI: 10.3390/jcm12206614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/11/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Post-operative acute kidney injury (PO-AKI) is a serious complication that may occur after major abdominal surgery. The administration of intravenous perioperative amino acids (AAs) has been proven to increase kidney function and has some beneficial effects to prevent PO-AKI. The aim of this study was to establish if the perioperative infusion of AAs may reduce the incidence of PO-AKI in patients undergoing major urological minimally invasive surgery. From a total of 331 patients, the first 169 received perioperative crystalloid fluids and the following 162 received perioperative AA infusions. PO-AKIs were much higher in the crystalloid group compared to the AA group (34 vs. 17, p = 0.022) due to a lower incidence of KDIGO I and II in the AA group (14 vs. 30 p = 0.016). The AA group patients who developed a PO-AKI presented more risk factors compared to those who did not (2 (2-4) vs. 1 (1-2), p = 0.031) with a cut-off of 3 risk factors in the ROC curve (p = 0.007, sensitivity 47%, specificity 83%). The hospital length of stay was higher in the crystalloid group (p < 0.05) with a consequent saving in hospital costs. Perioperative AA infusion may help reduce the incidence of PO-AKI after major urological minimally invasive surgery.
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Affiliation(s)
- Claudia Brusasco
- Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, 16128 Genoa, Italy;
| | - Fabio Maria Valenzi
- Urology Unit, Department of Medico-Surgical Sciences & Biotechnologies, Faculty of Pharmacy & Medicine, Sapienza University of Rome, 04100 Latina, Italy; (F.M.V.); (A.C.)
| | - Marco Micali
- Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, 16128 Genoa, Italy;
| | - Marco Ennas
- Urology Unit, E.O. Ospedali Galliera, 16128 Genoa, Italy; (M.E.); (A.D.D.); (F.G.); (F.D.); (A.B.); (F.C.); (C.I.)
| | - Antonia Di Domenico
- Urology Unit, E.O. Ospedali Galliera, 16128 Genoa, Italy; (M.E.); (A.D.D.); (F.G.); (F.D.); (A.B.); (F.C.); (C.I.)
| | - Federico Germinale
- Urology Unit, E.O. Ospedali Galliera, 16128 Genoa, Italy; (M.E.); (A.D.D.); (F.G.); (F.D.); (A.B.); (F.C.); (C.I.)
| | - Federico Dotta
- Urology Unit, E.O. Ospedali Galliera, 16128 Genoa, Italy; (M.E.); (A.D.D.); (F.G.); (F.D.); (A.B.); (F.C.); (C.I.)
| | - Andrea Benelli
- Urology Unit, E.O. Ospedali Galliera, 16128 Genoa, Italy; (M.E.); (A.D.D.); (F.G.); (F.D.); (A.B.); (F.C.); (C.I.)
| | - Fabio Campodonico
- Urology Unit, E.O. Ospedali Galliera, 16128 Genoa, Italy; (M.E.); (A.D.D.); (F.G.); (F.D.); (A.B.); (F.C.); (C.I.)
| | - Giada Cucciolini
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (G.C.); (F.C.)
| | - Antonio Carbone
- Urology Unit, Department of Medico-Surgical Sciences & Biotechnologies, Faculty of Pharmacy & Medicine, Sapienza University of Rome, 04100 Latina, Italy; (F.M.V.); (A.C.)
| | - Carlo Introini
- Urology Unit, E.O. Ospedali Galliera, 16128 Genoa, Italy; (M.E.); (A.D.D.); (F.G.); (F.D.); (A.B.); (F.C.); (C.I.)
| | - Francesco Corradi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (G.C.); (F.C.)
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Roy R, MacDonald J, Dark P, Kalra PA, Green D. The estimation of glomerular filtration in acute and critical illness: Challenges and opportunities. Clin Biochem 2023; 118:110608. [PMID: 37479107 DOI: 10.1016/j.clinbiochem.2023.110608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/23/2023]
Abstract
Recent events have made it apparent that the creatinine based estimating equations for glomerular filtration have their flaws. Some flaws have been known for some time; others have prompted radical modification of the equations themselves. These issues persist in part owing to the behaviour of the creatinine molecule itself, particularly in acute and critical illness. There are significant implications for patient treatment decisions, including drug and fluid therapies and choice of imaging modality (contrast vs. non-contrast CT scan for example). An alternative biomarker, Cystatin C, has been used with some success both alone and in combination with creatinine to help improve the accuracy of particular estimating equations. Problems remain in certain circumstances and costs may limit the more widespread use of the alternative assay. This review will explore both the historical and more recent evidence for glomerular filtration estimation, including options to directly measure glomerular filtration (rather than estimate), perhaps the holy grail for both Biochemistry and Nephrology.
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Affiliation(s)
- Reuben Roy
- The University of Manchester, Manchester, Greater Manchester, United Kingdom.
| | - John MacDonald
- Northern Care Alliance NHS Foundation Trust Salford Care Organisation, Salford, Greater Manchester M6 8HD, United Kingdom
| | - Paul Dark
- The University of Manchester, Manchester, Greater Manchester, United Kingdom
| | - Philip A Kalra
- Northern Care Alliance NHS Foundation Trust Salford Care Organisation, Salford, Greater Manchester M6 8HD, United Kingdom
| | - Darren Green
- Northern Care Alliance NHS Foundation Trust Salford Care Organisation, Salford, Greater Manchester M6 8HD, United Kingdom
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Ozkurt S, Ozakin E, Gungor H, Yalcin AU. Assessment of Renal Function of Bodybuilders Using Anabolic Androgenic Steroids and Diet Supplements. Cureus 2023; 15:e43058. [PMID: 37680426 PMCID: PMC10481367 DOI: 10.7759/cureus.43058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction Anabolic androgenic steroids (AAS) and diet supplements (DS) are frequently used by bodybuilders. In this specific group, increased muscle mass, the acute effects of exercise, and the use of creatine may affect the creatinine-based estimated glomerular filtration rate (eGFRcr), potentially leading to an underestimation of the GFR. Cystatin C equations offer a more accurate prediction of GFR that is independent of muscle mass. We aimed to assess the renal functions of bodybuilders who use both AAS+DS, as well as those who only use DS, by calculating the GFR based on cystatin C (eGFRcys) and also using a combination of cystatin C and creatinine (eGFRcys/cr). Methods The study included 12 bodybuilders using AAS+DS and 12 bodybuilders using DS. In both groups, serum cystatin C levels, eGFRcys, eGFRcys/cr, urine albumin excretion rates, urine protein excretion rates, and routine tests were examined. Results In AAS+DS users, the average duration of AAS use was 3.08±2.02 years, while for DS users, the duration of supplement use was 3.67±2.49 years. The spot urine albumin/creatinine and protein/creatinine ratios were higher in AAS+DS users (p<0.001 and p=0.006, respectively). Although eGFRcr was found to be similar in the AAS+DS and DS groups (119.67 ± 24.12 ml/min and 122.08 ± 18.03 ml/min, respectively; p=0.426), eGFRcys and the eGFRcys/cr ratio were significantly lower in the AAS+DS group compared to the DS group (eGFRcys: 120.67 ± 19.48 ml/min vs. 122.08 ± 18.03 ml/min, p=0.039; eGFRcys/cr: 121.83 ± 20.62 ml/min vs. 126.33 ± 21.163 ml/min, p= 0.036, respectively). Conclusion Cystatin-based GFR values were found to be significantly lower in AAS+DS users, and urinary albumin and protein excretion were considerably higher compared to DS users. Although these findings suggest a potential link between early kidney damage and the direct use of AAS, the topic requires further investigation.
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Affiliation(s)
- Sultan Ozkurt
- Nephrology, Faculty of Medicine, Eskişehir Osmangazi Üniversitesi, Eskişehir, TUR
| | - Engin Ozakin
- Emergency Medicine, Faculty of Medicine, Eskişehir Osmangazi Üniversitesi, Eskişehir, TUR
| | - Hilal Gungor
- Internal Medicine, Eskişehir City Hospital, Eskişehir, TUR
| | - Ahmet Ugur Yalcin
- Nephrology, Faculty of Medicine, Eskişehir Osmangazi Üniversitesi, Eskişehir, TUR
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Bardhi O, Clegg DJ, Palmer BF. The Role of Dietary Potassium in the Cardiovascular Protective Effects of Plant-Based Diets. Semin Nephrol 2023; 43:151406. [PMID: 37544060 DOI: 10.1016/j.semnephrol.2023.151406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Dietary intervention is an essential factor in managing a multitude of chronic health conditions such as cardiovascular and chronic kidney disease. In recent decades, there has been a host of research suggesting the potential benefit of plant-based diets in mitigating the health outcomes of these conditions. Plant-based diets are rich in vegetables and fruits, while limiting processed food and animal protein sources. The underlying physiological mechanism involves the interaction of several macronutrients and micronutrients such as plant protein, carbohydrates, and dietary potassium. Specifically, plant-based foods rich in potassium provide cardiorenal protective effects to include urinary alkalization and increased sodium excretion. These diets induce adaptive physiologic responses that improve kidney and cardiovascular hemodynamics and improve overall metabolic health. A shift toward consuming plant-based diets even in subjects with cardiorenal decrements may reduce their morbidity and mortality. Nonetheless, randomized controlled trials are needed to confirm the clinical benefits of plant-based diets.
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Affiliation(s)
- Olgert Bardhi
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Deborah J Clegg
- Department of Internal Medicine, Texas Tech Health Sciences Center, El Paso, TX
| | - Biff F Palmer
- Department of Internal Medicine, Texas Tech Health Sciences Center, El Paso, TX; Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
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Intravenous amino acid therapy for kidney protection in cardiac surgery a protocol for a multi-centre randomized blinded placebo controlled clinical trial. The PROTECTION trial. Contemp Clin Trials 2022; 121:106898. [PMID: 36038001 DOI: 10.1016/j.cct.2022.106898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/04/2022] [Accepted: 08/23/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Postoperative acute kidney injury (AKI) is frequent in cardiac surgery patients. Its pathophysiology is complex and involves decreased renal perfusion. Preliminary clinical evidence in critically ill patients shows that amino acids infusion increases renal blood flow and may decrease the incidence and severity of AKI. We designed a study to evaluate the effectiveness of perioperative continuous infusion of amino acids in decreasing AKI. METHODS This is a phase III, multi-center, randomized, double-blind, placebo-controlled trial. Adults undergoing cardiac surgery with cardiopulmonary bypass (CPB) are included. Patients are randomly assigned to receive either continuous infusion of a balanced mixture of amino acids in a dose of 2 g/kg ideal body weight/day or placebo (balanced crystalloid solution) from the operating room up to start of renal replacement therapy (RRT), or ICU discharge, or 72 h after the first dose. The primary outcome is the incidence of AKI during hospital stay defined by KDIGO (Kidney Disease: Improving Global Outcomes). Secondary outcomes include the need for, and duration of, RRT, mechanical ventilation; ICU and hospital length of stay; all-cause mortality at ICU, hospital discharge, 30, 90, and 180 days after randomization; quality of life at 180 days. Data will be analyzed in 3500 patients on an intention-to-treat basis. DISCUSSION The trial is ongoing and currently recruiting. It will be one of the first randomized controlled studies to assess the relationship between amino acids use and kidney injury in cardiac surgery. If our hypothesis is confirmed, this practice could reduce morbidity in the studied population. STUDY REGISTRATION This trial was registered on ClinicalTrials.gov with the trial identification NCT03709264 in October 2018.
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Husain-Syed F, Emlet DR, Wilhelm J, Danesi TH, Ferrari F, Bezerra P, Lopez-Giacoman S, Villa G, Tello K, Birk HW, Seeger W, Giavarina D, Salvador L, Fuhrman DY, Kellum JA, Ronco C. Effects of preoperative high-oral protein loading on short- and long-term renal outcomes following cardiac surgery: a cohort study. J Transl Med 2022; 20:204. [PMID: 35538495 PMCID: PMC9092825 DOI: 10.1186/s12967-022-03410-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 04/24/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Post-cardiac surgery acute kidney injury (AKI) is associated with increased mortality. A high-protein meal enhances the renal blood flow and glomerular filtration rate (GFR) and might protect the kidneys from acute ischemic insults. Hence, we assessed the effect of a preoperative high-oral protein load on post-cardiac surgery renal function and used experimental models to elucidate mechanisms by which protein might stimulate kidney-protective effects. METHODS The prospective "Preoperative Renal Functional Reserve Predicts Risk of AKI after Cardiac Operation" study follow-up was extended to postoperative 12 months for 109 patients. A 1:2 ratio propensity score matching method was used to identify a control group (n = 214) to comparatively evaluate the effects of a preoperative protein load and standard care. The primary endpoints were AKI development and postoperative estimated GFR (eGFR) loss at 3 and 12 months. We also assessed the secretion of tissue inhibitor of metalloproteases-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7), biomarkers implicated in mediating kidney-protective mechanisms in human kidney tubular cells that we exposed to varying protein concentrations. RESULTS The AKI rate did not differ between the protein loading and control groups (13.6 vs. 12.3%; p = 0.5). However, the mean eGFR loss was lower in the former after 3 months (0.1 [95% CI - 1.4, - 1.7] vs. - 3.3 [95% CI - 4.4, - 2.2] ml/min/1.73 m2) and 12 months (- 2.7 [95% CI - 4.2, - 1.2] vs - 10.2 [95% CI - 11.3, - 9.1] ml/min/1.73 m2; p < 0.001 for both). On stratification based on AKI development, the eGFR loss after 12 months was also found to be lower in the former (- 8.0 [95% CI - 14.1, - 1.9] vs. - 18.6 [95% CI - 23.3, - 14.0] ml/min/1.73 m2; p = 0.008). A dose-response analysis of the protein treatment of the primary human proximal and distal tubule epithelial cells in culture showed significantly increased IGFBP7 and TIMP-2 expression. CONCLUSIONS A preoperative high-oral protein load did not reduce AKI development but was associated with greater renal function preservation in patients with and without AKI at 12 months post-cardiac surgery. The potential mechanisms of action by which protein loading may induce a kidney-protective response might include cell cycle inhibition of renal tubular epithelial cells. Clinical trial registration ClinicalTrials.gov: NCT03102541 (retrospectively registered on April 5, 2017) and ClinicalTrials.gov: NCT03092947 (retrospectively registered on March 28, 2017).
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Affiliation(s)
- Faeq Husain-Syed
- grid.416303.30000 0004 1758 2035Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Via Rodolfi, 37, 36100 Vicenza, Italy ,grid.411067.50000 0000 8584 9230Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392 Giessen, Germany
| | - David R. Emlet
- grid.21925.3d0000 0004 1936 9000Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15261 USA
| | - Jochen Wilhelm
- grid.8664.c0000 0001 2165 8627Institute for Lung Health, Justus-Liebig-University Giessen, Ludwigstrasse 23, 35390 Giessen, Germany
| | - Tommaso Hinna Danesi
- grid.416303.30000 0004 1758 2035Department of Cardiac Surgery, San Bortolo Hospital, Via Rodolfi, 37, 36100 Vicenza, Italy ,grid.24827.3b0000 0001 2179 9593Division of Cardiac Surgery, Department of Surgery, College of Medicine, University of Cincinnaci, 231 Albert Sabin Way, Cincinnati, OH 45267-0558 USA
| | - Fiorenza Ferrari
- grid.416303.30000 0004 1758 2035Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Via Rodolfi, 37, 36100 Vicenza, Italy ,grid.419425.f0000 0004 1760 3027Intensive Care Unit, I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100 Pavia, Italy
| | - Pércia Bezerra
- grid.416303.30000 0004 1758 2035Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Via Rodolfi, 37, 36100 Vicenza, Italy
| | - Salvador Lopez-Giacoman
- grid.416303.30000 0004 1758 2035Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Via Rodolfi, 37, 36100 Vicenza, Italy
| | - Gianluca Villa
- grid.416303.30000 0004 1758 2035Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Via Rodolfi, 37, 36100 Vicenza, Italy ,grid.8404.80000 0004 1757 2304Department of Health Science, Section of Anesthesiology and Intensive Care, University of Florence, Piazza San Marco, 4, 50121 Florence, Italy
| | - Khodr Tello
- grid.411067.50000 0000 8584 9230Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392 Giessen, Germany ,grid.8664.c0000 0001 2165 8627Member of the German Centre for Lung Research, Universities of Giessen and Marburg Lung Centre, Klinikstrasse 33, 35392 Giessen, Germany
| | - Horst-Walter Birk
- grid.411067.50000 0000 8584 9230Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392 Giessen, Germany
| | - Werner Seeger
- grid.411067.50000 0000 8584 9230Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392 Giessen, Germany ,grid.8664.c0000 0001 2165 8627Member of the German Centre for Lung Research, Universities of Giessen and Marburg Lung Centre, Klinikstrasse 33, 35392 Giessen, Germany ,grid.418032.c0000 0004 0491 220XDepartment of Lung Development and Remodelling, Max Planck Institute for Heart and Lung Research, Ludwigstrasse 43, 61231 Bad Nauheim, Germany
| | - Davide Giavarina
- grid.416303.30000 0004 1758 2035Department of Clinical Chemistry and Hematology Laboratory, San Bortolo Hospital, Via Rodolfi, 37, 36100 Vicenza, Italy
| | - Loris Salvador
- grid.416303.30000 0004 1758 2035Department of Cardiac Surgery, San Bortolo Hospital, Via Rodolfi, 37, 36100 Vicenza, Italy
| | - Dana Y. Fuhrman
- grid.21925.3d0000 0004 1936 9000Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15261 USA ,grid.412689.00000 0001 0650 7433Departments of Critical Care Medicine and Pediatrics, Children’s Hospital of University of Pittsburgh Medical Center, One Children’s Hospital Way, 4401 Penn Ave, Pittsburgh, PA 15224 USA
| | - John A. Kellum
- grid.21925.3d0000 0004 1936 9000Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15261 USA
| | - Claudio Ronco
- grid.416303.30000 0004 1758 2035Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Via Rodolfi, 37, 36100 Vicenza, Italy ,grid.5608.b0000 0004 1757 3470Department of Medicine (DIMED), Università di Padova, Via Giustiniani, 2, 35128 Padua, Italy
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A low aromatic amino-acid diet improves renal function and prevent kidney fibrosis in mice with chronic kidney disease. Sci Rep 2021; 11:19184. [PMID: 34584168 PMCID: PMC8479128 DOI: 10.1038/s41598-021-98718-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/06/2021] [Indexed: 01/18/2023] Open
Abstract
Despite decades of use of low protein diets (LPD) in the management of chronic kidney disease (CKD), their mechanisms of action are unclear. A reduced production of uremic toxins could contribute to the benefits of LPDs. Aromatic amino-acids (AA) are precursors of major uremic toxins such as p-cresyl sulfate (PCS) and indoxyl sulfate (IS). We hypothesize that a low aromatic amino acid diet (LA-AAD, namely a low intake of tyrosine, tryptophan and phenylalanine) while being normoproteic, could be as effective as a LPD, through the decreased production of uremic toxins. Kidney failure was chemically induced in mice with a diet containing 0.25% (w/w) of adenine. Mice received three different diets for six weeks: normoproteic diet (NPD: 14.7% proteins, aromatic AAs 0.019%), LPD (5% proteins, aromatic AAs 0.007%) and LA-AAD (14% proteins, aromatic AAs 0.007%). Both LPD and LA-AAD significantly reduced proteinuria, kidney fibrosis and inflammation. While LPD only slightly decreased plasma free PCS and free IS compared to NPD; free fractions of both compounds were significantly decreased by LA-AAD. These results suggest that a LA-AAD confers similar benefits of a LPD in delaying the progression of CKD through a reduction in some key uremic toxins production (such as PCS and IS), with a lower risk of malnutrition.
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Cantaluppi V, Guglielmetti G, Dellepiane S, Marengo M, Mehta RL, Ronco C. A call to action to evaluate renal functional reserve in patients with COVID-19. Am J Physiol Renal Physiol 2020; 319:F792-F795. [PMID: 32969711 PMCID: PMC7641895 DOI: 10.1152/ajprenal.00245.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/19/2020] [Accepted: 09/07/2020] [Indexed: 12/27/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) poses an unprecedented challenge to world health systems, substantially increasing hospitalization and mortality rates in all affected countries. Being primarily a respiratory disease, COVID-19 is mainly associated with pneumonia or minor upper respiratory tract symptoms; however, different organs can sustain considerable (if not terminal) damage because of coronavirus. Acute kidney injury is the most common complication of COVID-19-related pneumonia, and more than 20% of patients requiring ventilatory support develop renal failure. Additionally, chronic kidney disease is a major risk factor for COVID-19 severity and mortality. All these data demonstrate the relevance of renal function assessment in patients with COVID-19 and the need of early kidney-directed diagnostic and therapeutic approaches. However, the sole assessment of renal function could be not entirely indicative of kidney tissue status. In this viewpoint, we discuss the clinical significance and potential relevance of renal functional reserve evaluation in patients with COVID-19.
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Affiliation(s)
- Vincenzo Cantaluppi
- Nephrology and Kidney Transplantation Unit, Department of Translational Medicine, University of Piemonte Orientale, "Maggiore della Carità" University Hospital, Novara, Italy
| | - Gabriele Guglielmetti
- Nephrology and Kidney Transplantation Unit, Department of Translational Medicine, University of Piemonte Orientale, "Maggiore della Carità" University Hospital, Novara, Italy
| | - Sergio Dellepiane
- Nephrology and Kidney Transplantation Unit, Department of Translational Medicine, University of Piemonte Orientale, "Maggiore della Carità" University Hospital, Novara, Italy
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Ravindra L Mehta
- Department of Medicine, University of California, San Diego, California
| | - Claudio Ronco
- Department of Medicine, University of Padova, Padova, Italy
- Division of Nephrology, Dialysis and Kidney Transplantation Unit, International Renal Research Institute Vicenza, "San Bortolo" Hospital, Vicenza, Italy
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Jufar AH, Lankadeva YR, May CN, Cochrane AD, Bellomo R, Evans RG. Renal functional reserve: from physiological phenomenon to clinical biomarker and beyond. Am J Physiol Regul Integr Comp Physiol 2020; 319:R690-R702. [PMID: 33074016 DOI: 10.1152/ajpregu.00237.2020] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Glomerular filtration rate (GFR) is acutely increased following a high-protein meal or systemic infusion of amino acids. The mechanisms underlying this renal functional response remain to be fully elucidated. Nevertheless, they appear to culminate in preglomerular vasodilation. Inhibition of the tubuloglomerular feedback signal appears critical. However, nitric oxide, vasodilator prostaglandins, and glucagon also appear important. The increase in GFR during amino acid infusion reveals a "renal reserve," which can be utilized when the physiological demand for single nephron GFR increases. This has led to the concept that in subclinical renal disease, before basal GFR begins to reduce, renal functional reserve can be recruited in a manner that preserves renal function. The extension of this concept is that once a decline in basal GFR can be detected, renal disease is already well progressed. This concept likely applies both in the contexts of chronic kidney disease and acute kidney injury. Critically, its corollary is that deficits in renal functional reserve have the potential to provide early detection of renal dysfunction before basal GFR is reduced. There is growing evidence that the renal response to infusion of amino acids can be used to identify patients at risk of developing either chronic kidney disease or acute kidney injury and as a treatment target for acute kidney injury. However, large multicenter clinical trials are required to test these propositions. A renewed effort to understand the renal physiology underlying the response to amino acid infusion is also warranted.
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Affiliation(s)
- Alemayehu H Jufar
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia.,Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Yugeesh R Lankadeva
- Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Clive N May
- Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew D Cochrane
- Department of Cardiothoracic Surgery, Monash Health and Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia
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11
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Hamill MJ, Afeyan R, Chakravarthy MV, Tramontin T. Endogenous Metabolic Modulators: Emerging Therapeutic Potential of Amino Acids. iScience 2020; 23:101628. [PMID: 33103071 PMCID: PMC7569218 DOI: 10.1016/j.isci.2020.101628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Multifactorial disease pathophysiology is complex and incompletely addressed by existing targeted pharmacotherapies. Amino acids (AAs) and related metabolites and precursors are a class of endogenous metabolic modulators (EMMs) that have diverse biological functions and, thus, have been explored for decades as potential multifactorial disease treatments. Here, we review the literature on this class of EMMs in disease treatment, with a focus on the emerging clinical studies on AAs and related metabolites and precursors as single- and combination-agents targeted to a single biology. These clinical research insights, in addition to increasing understanding of disease metabolic profiles and combinatorial therapeutic design principles, highlight an opportunity to develop EMM compositions with AAs and related metabolites and precursors to target multifactorial disease biology. EMM compositions are uniquely designed to enable a comprehensive approach, with potential to simultaneously and safely target pathways underlying multifactorial diseases and to regulate biological processes that promote overall health.
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12
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Carrero JJ, González-Ortiz A, Avesani CM, Bakker SJL, Bellizzi V, Chauveau P, Clase CM, Cupisti A, Espinosa-Cuevas A, Molina P, Moreau K, Piccoli GB, Post A, Sezer S, Fouque D. Plant-based diets to manage the risks and complications of chronic kidney disease. Nat Rev Nephrol 2020; 16:525-542. [PMID: 32528189 DOI: 10.1038/s41581-020-0297-2] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2020] [Indexed: 02/07/2023]
Abstract
Traditional dietary recommendations for patients with chronic kidney disease (CKD) focus on the quantity of nutrients consumed. Without appropriate dietary counselling, these restrictions can result in a low intake of fruits and vegetables and a lack of diversity in the diet. Plant nutrients and plant-based diets could have beneficial effects in patients with CKD: increased fibre intake shifts the gut microbiota towards reduced production of uraemic toxins; plant fats, particularly olive oil, have anti-atherogenic effects; plant anions might mitigate metabolic acidosis and slow CKD progression; and as plant phosphorus has a lower bioavailability than animal phosphorus, plant-based diets might enable better control of hyperphosphataemia. Current evidence suggests that promoting the adoption of plant-based diets has few risks but potential benefits for the primary prevention of CKD, as well as for delaying progression in patients with CKD G3-5. These diets might also help to manage and prevent some of the symptoms and metabolic complications of CKD. We suggest that restriction of plant foods as a strategy to prevent hyperkalaemia or undernutrition should be individualized to avoid depriving patients with CKD of these potential beneficial effects of plant-based diets. However, research is needed to address knowledge gaps, particularly regarding the relevance and extent of diet-induced hyperkalaemia in patients undergoing dialysis.
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Affiliation(s)
- Juan J Carrero
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Ailema González-Ortiz
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador, Zubirán, Mexico
| | - Carla M Avesani
- Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Vincenzo Bellizzi
- Nephrology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Philippe Chauveau
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux et Aurad-Aquitaine, Bordeaux, France
| | - Catherine M Clase
- Departments of Medicine and Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Angeles Espinosa-Cuevas
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador, Zubirán, Mexico
| | - Pablo Molina
- Department of Nephrology, Hospital Universitari Dr Peset, Universitat de València, València, Spain
| | - Karine Moreau
- Renal transplant unit, Pellegrin Hospital, Bordeaux, France
| | - Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy.,Nephrologie, Centre Hospitalier Le Mans, Le Mans, France
| | - Adrian Post
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Siren Sezer
- Department of Nephrology, Baskent University School of Medicine, Ankara, Turkey
| | - Denis Fouque
- Department of Nephrology, Université de Lyon, Carmen, Hospital Lyon-Sud, Lyon, France
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Wei J, Zhang J, Jiang S, Wang L, Persson AEG, Liu R. High-Protein Diet-Induced Glomerular Hyperfiltration Is Dependent on Neuronal Nitric Oxide Synthase β in the Macula Densa via Tubuloglomerular Feedback Response. Hypertension 2019; 74:864-871. [PMID: 31422689 DOI: 10.1161/hypertensionaha.119.13077] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
It is well known that high protein intake increases glomerular filtration rate. Evidence from several studies indicated that NO and tubuloglomerular feedback (TGF) mediate the effect. However, a recent study with a neuronal NO synthase-α knockout model refuted this mechanism and concluded that neither neuronal NO synthase nor TGF response is involved in the protein-induced hyperfiltration. To examine the discrepancy, this study tested a hypothesis that neuronal NO synthase-β in the macula densa mediates the high-protein diet-induced glomerular hyperfiltration via TGF mechanism. We examined the effects of high protein intake on NO generation at the macula densa, TGF response, and glomerular filtration rate in wild-type and macula densa-specific neuronal NO synthase KO mice. In wild-type mice, high-protein diet increased kidney weight, glomerular filtration rate, and renal blood flow, while reduced renal vascular resistance. TGF response in vivo and in vitro was blunted, and NO generation in the macula densa was increased following high-protein diet, associated with upregulations of neuronal NO synthase-β expression and phosphorylation at Ser1417. In contrast, these high-protein diet-induced changes in NO generation at the macula densa, TGF response, renal blood flow, and glomerular filtration rate in wild-type mice were largely attenuated in macula densa-specific neuronal NO synthase KO mice. In conclusion, we demonstrated that high-protein diet-induced glomerular hyperfiltration is dependent on neuronal NO synthase β in the macula densa via TGF response.
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Affiliation(s)
- Jin Wei
- From the Department of Molecular Pharmacology and Physiology, College of Medicine, University of South Florida, Tampa (J.W., J.Z., S.J., L.W., R.L.)
| | - Jie Zhang
- From the Department of Molecular Pharmacology and Physiology, College of Medicine, University of South Florida, Tampa (J.W., J.Z., S.J., L.W., R.L.)
| | - Shan Jiang
- From the Department of Molecular Pharmacology and Physiology, College of Medicine, University of South Florida, Tampa (J.W., J.Z., S.J., L.W., R.L.)
| | - Lei Wang
- From the Department of Molecular Pharmacology and Physiology, College of Medicine, University of South Florida, Tampa (J.W., J.Z., S.J., L.W., R.L.)
| | - A Erik G Persson
- Department of Medical Cell Biology, Division of Integrative Physiology, Uppsala University, Sweden (A.E.G.P.)
| | - Ruisheng Liu
- From the Department of Molecular Pharmacology and Physiology, College of Medicine, University of South Florida, Tampa (J.W., J.Z., S.J., L.W., R.L.)
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14
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Vives M, Hernandez A, Parramon F, Estanyol N, Pardina B, Muñoz A, Alvarez P, Hernandez C. Acute kidney injury after cardiac surgery: prevalence, impact and management challenges. Int J Nephrol Renovasc Dis 2019; 12:153-166. [PMID: 31303781 PMCID: PMC6612286 DOI: 10.2147/ijnrd.s167477] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 05/29/2019] [Indexed: 12/14/2022] Open
Abstract
Acute kidney injury (AKI) is a major medical problem that is of particular concern after cardiac surgery. Perioperative AKI is independently associated with an increase in short-term morbidity, costs of treatment, and long-term mortality. In this review, we explore the definition of cardiac surgery-associated acute kidney injury (CSA-AKI) and identify diverse mechanisms and risk factors contributing to the renal insult. Current theories of the pathophysiology of CSA-AKI and description of its clinical course will be addressed in this review. Data on the most promising renal protective strategies in cardiac surgery, from well-designed studies, will be scrutinized. Furthermore, diagnostic tools such as novel biomarkers of AKI and their potential utility will be discussed.
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Affiliation(s)
- M Vives
- Department of Anesthesiology & Critical Care, Clinical Research Lead, Hospital Universitari Dr Josep Trueta, Universitat de Girona, Institut d´Investigació Biomédica de Girona (IDIBGI), Girona, Spain
| | - A Hernandez
- Department of Anesthesia & Critical Care, Grupo Policlinica, Ibiza, Spain
| | - F Parramon
- Department of Anesthesiology & Critical Care Chief, Hospital Universitari Dr Josep Trueta, Universitat de Girona, Girona, Spain
| | - N Estanyol
- Department of Anesthesiology & Critical Care Chief, Hospital Universitari Dr Josep Trueta, Universitat de Girona, Girona, Spain
| | - B Pardina
- Department of Anesthesiology & Critical Care Chief, Hospital Universitari Dr Josep Trueta, Universitat de Girona, Girona, Spain
| | - A Muñoz
- Department of Anesthesiology & Critical Care Chief, Hospital Universitari Dr Josep Trueta, Universitat de Girona, Girona, Spain
| | - P Alvarez
- Department of Cardiac Surgery, Hospital Universitari Dr Josep Trueta, Universitat de Girona, Girona, Spain
| | - C Hernandez
- Department of Anesthesiology & Critical Care Chief, Hospital Universitari Dr Josep Trueta, Universitat de Girona, Girona, Spain
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15
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Pu H, Doig GS, Heighes PT, Allingstrup MJ, Wang A, Brereton J, Pollock C, Chesher D, Bellomo R. Intravenous amino acid therapy for kidney protection in cardiac surgery patients: A pilot randomized controlled trial. J Thorac Cardiovasc Surg 2019; 157:2356-2366. [DOI: 10.1016/j.jtcvs.2018.11.097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 01/21/2023]
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16
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Commentary: Acute kidney injury: The one-million-pieces puzzle. J Thorac Cardiovasc Surg 2019; 157:2367-2368. [DOI: 10.1016/j.jtcvs.2018.11.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 11/30/2018] [Indexed: 02/02/2023]
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17
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Wan L, Bellomo R, May CN. A Comparison of 4% Succinylated Gelatin Solution versus Normal Saline in Stable Normovolaemic Sheep: Global Haemodynamic, Regional Blood Flow and Oxygen Delivery Effects. Anaesth Intensive Care 2019; 35:924-31. [DOI: 10.1177/0310057x0703500611] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to compare the effects on regional blood flow and regional oxygen delivery of 4% succinylated gelatin solution (Gelofusine®, B. Braun) with those of normal saline. This was a randomised, controlled, crossover large animal study, which took place at the animal laboratory of university physiology institute. The subjects were seven merino cross-ewes. We implanted flow probes around the aorta, coronary, renal and mesenteric arteries. We randomised animals to observation (control), normal saline (one litre over 15 minutes) or Gelofusine* (one litre over 15 minutes). We measured central haemodynamics, organ blood flows, arterial blood gases and haemoglobin every 30 minutes for 210 minutes. Compared to control, both Gelofusine* and normal saline significantly and similarly increased mean arterial pressure, stroke volume, cardiac output and central venous pressure in the first hour (P <0.05). Such changes, however, were transient except for the increase in cardiac output seen with Gelofusine®. Normal saline significantly increased mesenteric blood flow in the first hour (P <0.05), while Gelofusine* caused a specific, sustained and progressive increase in renal blood flow and conductance (P <0.05). Both fluids increased urine output and creatinine clearance (P <0.05), but, due to haemodilution, both decreased renal oxygen delivery in the first hour (P <0.05). Normal saline and Gelofusine® have transient, volume expansion-related systemic haemodynamic effects, which are greater for Gelofusine®. Saline had a more pronounced early effect on mesenteric blood flow, while Gelofusine* had a sustained and progressive greater effect on renal blood flow. The transient increase in urine output and creatinine clearance seen with both fluids occurred while renal oxygen delivery decreased.
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Affiliation(s)
- L. Wan
- Department of Intensive Care, Austin Health and Howard Florey Institute and Department of Pharmacology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care, Austin Health
| | - R. Bellomo
- Department of Intensive Care, Austin Health and Howard Florey Institute and Department of Pharmacology, University of Melbourne, Melbourne, Victoria, Australia
- Director of Intensive Care Research, Department of Intensive Care, Austin Health
| | - C. N. May
- Department of Intensive Care, Austin Health and Howard Florey Institute and Department of Pharmacology, University of Melbourne, Melbourne, Victoria, Australia
- Howard Florey Institute, University of Melbourne
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18
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Brands MW. Role of Insulin-Mediated Antinatriuresis in Sodium Homeostasis and Hypertension. Hypertension 2018; 72:1255-1262. [DOI: 10.1161/hypertensionaha.118.11728] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Michael W. Brands
- From the Department of Physiology, Medical College of Georgia, Augusta, GA
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19
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De Moor B, Vanwalleghem JF, Swennen Q, Stas KJ, Meijers BKI. Haemodynamic or metabolic stimulation tests to reveal the renal functional response: requiem or revival? Clin Kidney J 2018; 11:623-654. [PMID: 30288259 PMCID: PMC6165749 DOI: 10.1093/ckj/sfy022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/26/2018] [Indexed: 12/24/2022] Open
Abstract
Renal stimulation tests document the dynamic response of the glomerular filtration rate (GFR) after a single or a combination of stimuli, such as an intravenous infusion of dopamine or amino acids or an oral protein meal. The increment of the GFR above the unstimulated state has formerly been called the renal functional reserve (RFR). Although the concept of a renal reserve capacity has not withstood scientific scrutiny, the literature documenting renal stimulation merits renewed interest. An absent or a blunted response of the GFR after a stimulus indicates lost or diseased nephrons. This information is valuable in preventing, diagnosing and prognosticating acute kidney injury and pregnancy-related renal events as well as chronic kidney disease. However, before renal function testing is universally practiced, some shortcomings must be addressed. First, a common nomenclature should be decided upon. The expression of RFR should be replaced by renal functional response. Second, a simple protocol must be developed and propagated. Third, we suggest designing prospective studies linking a defective stimulatory response to emergence of renal injury biomarkers, to histological or morphological renal abnormalities and to adverse renal outcomes in different renal syndromes.
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Affiliation(s)
- Bart De Moor
- Faculty of Medicine and Life Sciences, University of Hasselt, Diepenbeek, Belgium
- Department of Nephrology, Jessa Hospital of Hasselt, Hasselt, Belgium
| | | | - Quirine Swennen
- Faculty of Medicine and Life Sciences, University of Hasselt, Diepenbeek, Belgium
| | - Koen J Stas
- Department of Nephrology, Jessa Hospital of Hasselt, Hasselt, Belgium
| | - Björn K I Meijers
- Department of Nephrology, Universitair Ziekenhuis Leuven, Leuven, Belgium
- Department of Immunology and Microbiology, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
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20
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Rahman RA, Bhatnagar V, Agarwala S, Kumar R. Estimation of Renal Functional Reserve in Children with Different Grades of Vesicoureteric Reflux. J Indian Assoc Pediatr Surg 2018; 23:74-80. [PMID: 29681697 PMCID: PMC5898208 DOI: 10.4103/jiaps.jiaps_213_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Vesicoureteric reflux (VUR) is one of the most common anomalies encountered in pediatric urology. The concept of renal functional reserve (RFR) as the ability of the kidney to increase glomerular filtration rate (GFR) following a protein load was introduced in the 1980s. Aim This study aims to evaluate RFR using 99Tc diethylenetriamine pentaacetic acid (DTPA) as the filtration agent for GFR estimation in children with VUR. Materials and Methods RFR was estimated in 53 children, of which 31 patients had unilateral VUR (Group I) and 22 patients had bilateral VUR (Group II), by subtracting baseline GFR from stimulated GFR following an intravenous protein load. GFR was determined by double compartment-2 sample method using 99Tc DTPA radioisotope as the filtration agent. Both the groups were further subgrouped into low-grade (IA, IIA) and high-grade VUR (IB, IIB). Results The RFR was significantly lower in unilateral high-grade VUR (Group IB) as compared to unilateral low-grade VUR (Group IA) (P = 0.024). RFR was significantly lower in bilateral high-grade VUR patients (IIB) as compared to unilateral low-grade VUR group (IA) (P = 0.0226). Furthermore, the stimulated GFR shows very strong correlation to baseline GFR in both major groups (r = 0.9659 and P = 0.001 in Group I and r = 0.9856 and P = 0.001 in Group II) concluding that the baseline GFR and the stimulated GFR increase or decrease in tandem in both the groups. Conclusion The RFR is impaired in children with both unilateral high-grade VUR and bilateral high-grade VUR while it is relatively preserved in unilateral low-grade VUR and bilateral low-grade VUR.
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Affiliation(s)
- Rafey Abdul Rahman
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Veereshwar Bhatnagar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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21
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Chauveau P, Aparicio M, Bellizzi V, Campbell K, Hong X, Johansson L, Kolko A, Molina P, Sezer S, Wanner C, ter Wee PM, Teta D, Fouque D, Carrero JJ. Mediterranean diet as the diet of choice for patients with chronic kidney disease. Nephrol Dial Transplant 2017; 33:725-735. [DOI: 10.1093/ndt/gfx085] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/05/2017] [Indexed: 02/07/2023] Open
Affiliation(s)
- Philippe Chauveau
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux et Aurad-Aquitaine, Bordeaux, France
| | - Michel Aparicio
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux et Aurad-Aquitaine, Bordeaux, France
| | - Vincenzo Bellizzi
- Division of Nephrology, Dialysis and Renal Transplantation, University Hospital "San Giovanni di Dio e Ruggi d’Aragona", Salerno, Italy
| | - Katrina Campbell
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Xu Hong
- Division of Renal Medicine, CLINTEC and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lina Johansson
- Department of Nutrition and Dietetics, Imperial College Healthcare NHS Trust, London, England
| | - Anne Kolko
- Association pour l'Utilisation du Rein Artificiel en région Parisienne (AURA) Paris, Paris, France
| | - Pablo Molina
- Department of Nephrology, Dr Peset University Hospital, Valencia, Spain
| | - Siren Sezer
- Department of Nephrology, Başkent University Hospital, Ankara, Turkey
| | | | | | - Daniel Teta
- Service of Nephrology, Hôpital du Valais, Sion and Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Denis Fouque
- Department of Nephrology, Centre Hospitalier Lyon-Sud, Université de Lyon, UCBL, Carmen, Pierre, Bénite, France
| | - Juan J Carrero
- Division of Renal Medicine, CLINTEC and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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22
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Abstract
Chronic kidney disease (CKD) has a prevalence of approximately 13% and is most frequently caused by diabetes and hypertension. In population studies, CKD etiology is often uncertain. Some experimental and observational human studies have suggested that high-protein intake may increase CKD progression and even cause CKD in healthy people. The protein source may be important. Daily red meat consumption over years may increase CKD risk, whereas white meat and dairy proteins appear to have no such effect, and fruit and vegetable proteins may be renal protective. Few randomized trials exist with an observation time greater than 6 months, and most of these were conducted in patients with preexisting diseases that dispose to CKD. Results conflict and do not allow any conclusion about kidney-damaging effects of long-term, high-protein intake. Until additional data become available, present knowledge seems to substantiate a concern. Screening for CKD should be considered before and during long-term, high-protein intake.
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Affiliation(s)
- Anne-Lise Kamper
- Department of Nephrology, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark;
| | - Svend Strandgaard
- Department of Nephrology, Herlev Hospital, University of Copenhagen, 2730 Copenhagen, Denmark;
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23
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Kelly JT, Carrero JJ. Dietary Sources of Protein and Chronic Kidney Disease Progression: The Proof May Be in the Pattern. J Ren Nutr 2017; 27:221-224. [PMID: 28549571 DOI: 10.1053/j.jrn.2017.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 04/10/2017] [Indexed: 01/22/2023] Open
Affiliation(s)
- Jaimon T Kelly
- Faculty of Health Sciences and Medicine, Bond University, Bond, Australia
| | - Juan Jesús Carrero
- Division of Renal Medicine and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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24
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Kanazawa Y, Morita S, Sonoki H, Nakao T. Effects of a novel nutritional formula specially developed for chronic kidney disease patients on protein-restricted diets: a randomized controlled trial. RENAL REPLACEMENT THERAPY 2016. [DOI: 10.1186/s41100-016-0031-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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25
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Gaipov A, Solak Y, Zhampeissov N, Dzholdasbekova A, Popova N, Molnar MZ, Tuganbekova S, Iskandirova E. Renal functional reserve and renal hemodynamics in hypertensive patients. Ren Fail 2016; 38:1391-1397. [DOI: 10.1080/0886022x.2016.1214052] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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26
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Chawla LS, Ronco C. Renal Stress Testing in the Assessment of Kidney Disease. Kidney Int Rep 2016; 1:57-63. [PMID: 29142914 PMCID: PMC5678605 DOI: 10.1016/j.ekir.2016.04.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 11/02/2022] Open
Abstract
As part of human evolutionary development, many human organ systems have innate mechanisms to adapt to increased "work demand" or stress. This reserve capacity can be informative and is used commonly in cardiology to assess cardiac function (e.g., treadmill test). Similarly, the kidney possesses reserve capacity, which can be demonstrated in at least 2 of the following renal domains: glomerular and tubular. When appropriate stimulants are used, healthy patients with intact kidneys can significantly increase their glomerular filtration rate and their tubular secretion. This approach has been used to develop diagnostics for the assessment of renal function. This article reviews both glomerular and tubular kidney stress tests and their respective diagnostic utility.
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Affiliation(s)
- Lakhmir S Chawla
- Department of Medicine, Veterans Affairs Medical Center, Washington, DC, USA.,Department of Medicine, George Washington University, Washington, DC, USA
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute of Vicenza, Vicenza, Italy
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Tomat AL, Salazar FJ. Mechanisms involved in developmental programming of hypertension and renal diseases. Gender differences. Horm Mol Biol Clin Investig 2015; 18:63-77. [PMID: 25390003 DOI: 10.1515/hmbci-2013-0054] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 10/25/2013] [Indexed: 01/24/2023]
Abstract
BACKGROUND A substantial body of epidemiological and experimental evidence suggests that a poor fetal and neonatal environment may "program" susceptibility in the offspring to later development of cardiovascular, renal and metabolic diseases. MATERIALS AND METHODS This review focuses on current knowledge from the available literature regarding the mechanisms linking an adverse developmental environment with an increased risk for cardiovascular, renal and metabolic diseases in adult life. Moreover, this review highlights important sex-dependent differences in the adaptation to developmental insults. RESULTS Developmental programming of several diseases is secondary to changes in different mechanisms inducing important alterations in the normal development of several organs that lead to significant changes in birth weight. The different diseases occurring as a consequence of an adverse environment during development are secondary to morphological and functional cardiovascular and renal changes, to epigenetic changes and to an activation of several hormonal and regulatory systems, such as angiotensin II, sympathetic activity, nitric oxide, COX2-derived metabolites, oxidative stress and inflammation. The important sex-dependent differences in the developmental programming of diseases seem to be partly secondary to the effects of sex hormones. Recent studies have shown that the progression of these diseases is accelerated during aging in both sexes. CONCLUSIONS The cardiovascular, renal and metabolic diseases during adult life that occur as a consequence of several insults during fetal and postnatal periods are secondary to multiple structural and functional changes. Future studies are needed in order to prevent the origin and reduce the incidence and consequences of developmental programmed diseases.
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VASSAL O, BONNET JM, BARTHELEMY A, ALLAOUCHICHE B, GOY-THOLLOT I, LOUZIER V, PAQUET C, AYOUB JY, DAUWALDER O, JACQUET-LAGRÈZE M, JUNOT S. Renal haemodynamic response to amino acids infusion in an experimental porcine model of septic shock. Acta Anaesthesiol Scand 2015; 59:598-608. [PMID: 25782071 DOI: 10.1111/aas.12507] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 02/03/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is common in sepsis. Treatments allowing maintenance of renal blood flow (RBF) could help to prevent AKI associated with renal hypoperfusion. Amino acids (AA) have been associated with an increase of RBF and glomerular filtration rate (GFR) in several species. The aim of this study was to evaluate the effects of an AA infusion on RBF and GFR in a porcine model of septic shock. METHODS A total of 17 piglets were randomly assigned into three groups: Sham (Sham, n = 5), sepsis without AA (S-NAA, n = 6), sepsis treated with AA (S-AA, n = 6). Piglets preparation included the placement of ultrasonic transit time flow probes around left renal artery for continuous RBF measurement; ureteral catheters for GFR and urine output evaluation; pulmonary artery catheter for cardiac output (CO) and pulmonary arterial pressure measurements. Mean arterial pressure (MAP) and renal vascular resistance (RVR) were also determined. Septic shock was induced with a live Pseudomonas aeruginosa infusion. Crystalloids, colloids and epinephrine infusion were used to maintain and restore MAP > 60 mmHg and CO > 80% from baseline. RESULTS Renal haemodynamic did not change significantly in the Sham group, whereas RBF increased slightly in the S-NAA group. Conversely, a significant increase in RVR and a decrease in RBF and GFR were observed in the S-AA group. AA infusion was associated with a higher requirement of epinephrine [340.0 (141.2; 542.5) mg vs. 32.5 (3.8; 65.0) mg in the S-NAA group P = 0.044]. CONCLUSION An infusion of amino acids impaired renal haemodynamics in this experimental model of septic shock.
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Affiliation(s)
- O. VASSAL
- Service d'Anesthésie-Réanimation; Hospices Civils de Lyon; Hôpital Edouard-Herriot; Lyon France
- Université Claude-Bernard; Lyon France
| | - J.-M. BONNET
- Université de Lyon; EA 4174 Hémostase Inflammation Sepsis; VetAgro Sup - Campus Vétérinaire de Lyon; Marcy l'Etoile France
| | - A. BARTHELEMY
- Université de Lyon; EA 4174 Hémostase Inflammation Sepsis; VetAgro Sup - Campus Vétérinaire de Lyon; Marcy l'Etoile France
| | - B. ALLAOUCHICHE
- Service d'Anesthésie-Réanimation; Hospices Civils de Lyon; Hôpital Edouard-Herriot; Lyon France
- Université Claude-Bernard; Lyon France
| | - I. GOY-THOLLOT
- Université de Lyon; EA 4174 Hémostase Inflammation Sepsis; VetAgro Sup - Campus Vétérinaire de Lyon; Marcy l'Etoile France
| | - V. LOUZIER
- Université de Lyon; EA 4174 Hémostase Inflammation Sepsis; VetAgro Sup - Campus Vétérinaire de Lyon; Marcy l'Etoile France
| | - C. PAQUET
- Université de Lyon; EA 4174 Hémostase Inflammation Sepsis; VetAgro Sup - Campus Vétérinaire de Lyon; Marcy l'Etoile France
| | - J.-Y. AYOUB
- Université de Lyon; EA 4174 Hémostase Inflammation Sepsis; VetAgro Sup - Campus Vétérinaire de Lyon; Marcy l'Etoile France
| | - O. DAUWALDER
- Université de Lyon; Laboratory of Microbiology; Groupement Hospitalier Est; Lyon France
| | - M. JACQUET-LAGRÈZE
- Service d'Anesthésie-Réanimation; Hospices Civils de Lyon; Hôpital Edouard-Herriot; Lyon France
- Université Claude-Bernard; Lyon France
| | - S. JUNOT
- Université de Lyon; EA 4174 Hémostase Inflammation Sepsis; VetAgro Sup - Campus Vétérinaire de Lyon; Marcy l'Etoile France
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Doig GS, Simpson F, Bellomo R, Heighes PT, Sweetman EA, Chesher D, Pollock C, Davies A, Botha J, Harrigan P, Reade MC. Intravenous amino acid therapy for kidney function in critically ill patients: a randomized controlled trial. Intensive Care Med 2015; 41:1197-208. [PMID: 25925203 DOI: 10.1007/s00134-015-3827-9] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 04/15/2015] [Indexed: 01/11/2023]
Abstract
IMPORTANCE Acute kidney injury (AKI) is characterized by severe loss of glomerular filtration rate (GFR) and is associated with a prolonged intensive care unit (ICU) stay and increased risk of death. No interventions have yet been shown to prevent AKI or preserve GFR in critically ill patients. Evidence from mammalian physiology and small clinical trials suggests higher amino acid intake may protect the kidney from ischemic insults and thus may preserve GFR during critical illness. OBJECTIVE To determine whether amino acid therapy, achieved through daily intravenous (IV) supplementation with standard amino acids, preserves kidney function in critically ill patients. DESIGN, SETTING, AND PARTICIPANTS Multicenter, phase II, randomized clinical trial conducted between December 2010 and February 2013 in the ICUs of 16 community and tertiary hospitals in Australia and New Zealand. Participants were adult critically ill patients expected to remain in the study ICU for longer than 2 days. INTERVENTIONS Random allocation to receive a daily supplement of up to 100 g of IV amino acids or standard care. MAIN OUTCOMES AND MEASURES Duration of renal dysfunction (primary outcome); estimated GFR (eGFR) derived from creatinine; eGFR derived from cystatin C; urinary output; renal replacement therapy (RRT) use; fluid balance and other measures of renal function. RESULTS 474 patients were enrolled and randomized (235 to standard care, 239 to IV amino acid therapy). At time of enrollment, patients allocated to receive amino acid therapy had higher APACHE II scores (20.2 ± 6.8 vs. 21.7 ± 7.6, P = 0.02) and more patients had pre-existing renal dysfunction (29/235 vs. 44/239, P = 0.07). Duration of renal dysfunction after enrollment did not differ between groups (mean difference 0.21 AKI days per 10 patient ICU days, 95 % CI -0.27 to 1.04, P = 0.45). Amino acid therapy significantly improved eGFR (treatment group × time interaction, P = 0.004), with an early peak difference of 7.7 mL/min/1.73 m(2) (95 % CI 1.0-14.5 mL/min/1.73 m(2), P = 0.02) on study day 4. Daily urine output was also significantly increased (+300 mL/day, 95 % CI 145-455 mL, P = 0.0002). There was a trend towards increased RRT use in patients receiving amino acid therapy (13/235 vs. 25/239, P = 0.062); however, this trend was not present after controlling for baseline imbalance (P = 0.21). CONCLUSION AND RELEVANCE Treatment with a daily IV supplement of standard amino acids did not alter our primary outcome, duration of renal dysfunction. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12609001015235.
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Affiliation(s)
- Gordon S Doig
- The Northern Clinical School Intensive Care Research Unit, University of Sydney, Sydney, Australia,
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Buendia JR, Bradlee ML, Singer MR, Moore LL. Diets higher in protein predict lower high blood pressure risk in Framingham Offspring Study adults. Am J Hypertens 2015; 28:372-9. [PMID: 25194158 DOI: 10.1093/ajh/hpu157] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Short-term clinical trials suggest that dietary protein lowers blood pressure (BP); however, long-term effects of total, animal, and plant proteins are less clear. Our goal was to evaluate effects of these dietary proteins on mean systolic BP (SBP) and diastolic BP (DBP) and incident high BP (HBP) risk among middle-aged adults in the Framingham Offspring Study. METHODS Men and women (aged 30-54 years) without prevalent HBP, cardiovascular disease, or diabetes with 3-day dietary records from exams 3 or 5 (n = 1,361) were included and followed for a mean of 11.3 years for development of HBP. Protein intakes adjusted for body size were derived using the residual method. Analysis of covariance and Cox proportional hazard's models were used to adjust for age, sex, education, height, activity, smoking, fat calories, diet quality, and body mass index. RESULTS Higher protein intakes were associated with lower mean SBP and DBP. Both animal and plant proteins lowered BP and led to statistically significant reductions in HBP risk (hazard ratios of 0.68 and 0.51, respectively). Participants in the highest tertile of total protein intake had 40% less risk (95% confidence interval [CI], 0.45-0.78) of developing HBP. Beneficial effects of protein were apparent for men and women and for normal-weight and overweight individuals. Higher protein diets also characterized by higher fiber intakes led to a 59% reduction (95% CI, 0.37-0.66) in HBP risk. CONCLUSIONS Adults consuming more dietary protein from either plant or animal sources had lower long-term risks of HBP.
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Affiliation(s)
- Justin R Buendia
- Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - M Loring Bradlee
- Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Martha R Singer
- Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Lynn L Moore
- Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
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Akbari A, Clase CM, Acott P, Battistella M, Bello A, Feltmate P, Grill A, Karsanji M, Komenda P, Madore F, Manns BJ, Mahdavi S, Mustafa RA, Smyth A, Welcher ES. Canadian Society of Nephrology Commentary on the KDIGO Clinical Practice Guideline for CKD Evaluation and Management. Am J Kidney Dis 2015; 65:177-205. [DOI: 10.1053/j.ajkd.2014.10.013] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 10/31/2014] [Indexed: 12/24/2022]
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Mitrou N, Scully CG, Braam B, Chon KH, Cupples WA. Laser speckle contrast imaging reveals large-scale synchronization of cortical autoregulation dynamics influenced by nitric oxide. Am J Physiol Renal Physiol 2015; 308:F661-70. [PMID: 25587114 DOI: 10.1152/ajprenal.00022.2014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 01/08/2015] [Indexed: 11/22/2022] Open
Abstract
Synchronization of tubuloglomerular feedback (TGF) dynamics in nephrons that share a cortical radial artery is well known. It is less clear whether synchronization extends beyond a single cortical radial artery or whether it extends to the myogenic response (MR). We used LSCI to examine cortical perfusion dynamics in isoflurane-anesthetized, male Long-Evans rats. Inhibition of nitric oxide synthases by N(ω)-nitro-l-arginine methyl ester (l-NAME) was used to alter perfusion dynamics. Phase coherence (PC) was determined between all possible pixel pairs in either the MR or TGF band (0.09-0.3 and 0.015-0.06 Hz, respectively). The field of view (≈4 × 5 mm) was segmented into synchronized clusters based on mutual PC. During the control period, the field of view was often contained within one cluster for both MR and TGF. PC was moderate for TGF and modest for MR, although significant in both. In both MR and TGF, PC exhibited little spatial variation. After l-NAME, the number of clusters increased in both MR and TGF. MR clusters became more strongly synchronized while TGF clusters showed small highly coupled, high-PC regions that were coupled with low PC to the remainder of the cluster. Graph theory analysis probed modularity of synchronization. It confirmed weak synchronization of MR during control that probably was not physiologically relevant. It confirmed extensive and long-distance synchronization of TGF during control and showed increased modularity, albeit with larger modules seen in MR than in TGF after l-NAME. The results show widespread synchronization of MR and TGF that is differentially affected by nitric oxide.
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Affiliation(s)
- Nicholas Mitrou
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Christopher G Scully
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts; and
| | - Branko Braam
- Department of Medicine and Department of Physiology, University of Alberta, Edmonton, Alberta, Canada
| | - Ki H Chon
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts; and
| | - William A Cupples
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada;
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Sharma A, Mucino MJ, Ronco C. Renal functional reserve and renal recovery after acute kidney injury. Nephron Clin Pract 2014; 127:94-100. [PMID: 25343829 DOI: 10.1159/000363721] [Citation(s) in RCA: 173] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Renal functional reserve (RFR) represents the capacity of the kidney to increase glomerular filtration rate (GFR) in response to certain physiological or pathological stimuli or conditions. Once baseline GFR is determined, RFR can be assessed clinically after an oral protein load or intravenous amino acid infusion. In clinical practice, baseline GFR displays variable levels due to diet or other factors. RFR is the difference between peak 'stress' GFR induced by the test (p.o. or i.v.) and the baseline GFR. In clinical scenarios where hyperfiltration is present (high baseline GFR due to pregnancy, hypertension or diabetic nephropathy, in solitary kidney or kidney donors), RFR may be fully or partially used to achieve normal or supranormal renal function. Since commonly used renal function markers, such as GFR, may remain within normal ranges until 50% of nephrons are lost or in patients with a single remnant kidney, the RFR test may represent a sensitive and early way to assess the functional decline in the kidney. RFR assessment may become an important tool to evaluate the ability of the kidney to recover completely or partially after a kidney attack. In case of healing with a defect and progressive fibrosis, recovery may appear complete clinically, but a reduced RFR may be a sign of a maladaptive repair or subclinical loss of renal mass. Thus, a reduction in RFR may represent the equivalent of renal frailty or susceptibility to insults. The main aim of this article is to review the concept of RFR, its utility in different clinical scenarios, and future perspective for its use.
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Affiliation(s)
- Aashish Sharma
- International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy
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Reynolds BS, Brosse C, Jeunesse E, Concordet D, Lefebvre HP. Routine plasma biochemistry analytes in clinically healthy cats: within-day variations and effects of a standard meal. J Feline Med Surg 2014; 17:468-75. [PMID: 25139540 DOI: 10.1177/1098612x14546920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Limited information is available on pre-analytical variations in plasma analytes in cats. The objectives of this study were to assess the effects of the time of sampling and a standard meal on plasma analytes in healthy cats. Eight healthy, adult, fasted cats underwent blood sampling every 2 h from 8 am to 8 pm twice at a 12 day interval. On the days of sampling, four cats were kept fasted and the others were fed just after the first sample, in a crossover design. Plasma glucose, urea, creatinine, sodium, potassium, chloride, CO2, calcium, phosphate, proteins, albumin, cholesterol and triglycerides, alanine aminotransferase and alkaline phosphatase were assayed on each sample. Effects of time of sampling and meal on plasma biochemistry results were tested using a general linear model. Diurnal variations in tested plasma analytes in fasted cats were negligible except for urea and creatinine, which gave noticeably higher plasma concentrations in the afternoon than in the morning. Observed postprandial variations were of some importance for phosphate and creatinine and of indisputable clinical relevance for CO2 and urea.
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Affiliation(s)
- Brice S Reynolds
- Unité de Recherche Clinique, Université de Toulouse, INP, Ecole Nationale Vétérinaire de Toulouse, Toulouse, France
| | - Claire Brosse
- Unité de Recherche Clinique, Université de Toulouse, INP, Ecole Nationale Vétérinaire de Toulouse, Toulouse, France
| | - Elisabeth Jeunesse
- UMR 1331 Toxalim, INRA, Université de Toulouse, INP, Ecole Nationale Vétérinaire de Toulouse, Toulouse, France
| | - Didier Concordet
- UMR 1331 Toxalim, INRA, Université de Toulouse, INP, Ecole Nationale Vétérinaire de Toulouse, Toulouse, France
| | - Hervé P Lefebvre
- Unité de Recherche Clinique, Université de Toulouse, INP, Ecole Nationale Vétérinaire de Toulouse, Toulouse, France
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Friedman AN, Quinney SK, Inman M, Mattar SG, Shihabi Z, Moe S. Influence of dietary protein on glomerular filtration before and after bariatric surgery: a cohort study. Am J Kidney Dis 2014; 63:598-603. [PMID: 24387796 PMCID: PMC3969448 DOI: 10.1053/j.ajkd.2013.11.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 11/06/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Obesity-associated elevations in glomerular filtration rate (GFR) are common and may play a role in the development of kidney disease, so identifying the underlying mechanism is important. We therefore studied whether reductions in dietary protein intake, which is known to modulate GFR, explain why GFR decreases after bariatric surgery-induced weight loss. STUDY DESIGN Cohort study with participants as their own controls. SETTING & PARTICIPANTS 8 severely obese patients with normal kidney function were recruited from bariatric surgery centers in Indianapolis, IN. All participants were placed on a fixed-protein (50-g/d) diet for 1 week before and after a minimum of a 20-kg weight loss by bariatric surgery and were followed up closely by dieticians for adherence. PREDICTOR Ad lib versus low-protein diet before versus after bariatric surgery. OUTCOME Measured GFR, using repeated-measures analysis, was used to estimate the independent effects of diet and surgery. MEASUREMENT GFR was measured using plasma iohexol clearance. RESULTS A median of 32.9 (range, 19.5-54.4)kg was lost between the first presurgery visit and first postsurgery visit. Dietetic evaluations and urinary urea excretion confirmed that patients generally adhered to the study diet. GFRs on an ad lib diet were significantly higher before compared to after surgery (GFR medians were 144 (range, 114-178) and 107 (range, 85-147) mL/min, respectively; P=0.01). Although bariatric surgery (-26mL/min; P=0.005) and dietary sodium intake (+7.5mL/min per 100mg of dietary sodium; P=0.001) both influenced GFR, consuming a low-protein diet did not (P=0.7). LIMITATIONS Small sample size; mostly white women; possible lack of generalizability. CONCLUSIONS The decrease in GFR observed after bariatric surgery is explained at least in part by the effects of surgery and/or dietary sodium intake, but not by low dietary protein consumption.
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Affiliation(s)
- Allon N Friedman
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
| | - Sara K Quinney
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | | | - Samer G Mattar
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Zak Shihabi
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Sharon Moe
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; Department of Medicine, Roudebush Veterans Affairs Medical Center, Indianapolis, IN
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Reverte V, Tapia A, Loria A, Salazar F, Llinas MT, Salazar FJ. COX2 inhibition during nephrogenic period induces ANG II hypertension and sex-dependent changes in renal function during aging. Am J Physiol Renal Physiol 2013; 306:F534-41. [PMID: 24338820 DOI: 10.1152/ajprenal.00535.2013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study was performed to test the hypothesis that ANG II contributes to the hypertension and renal functional alterations induced by a decrease of COX2 activity during the nephrogenic period. It was also examined whether renal functional reserve and renal response to volume overload and high sodium intake are reduced in 3-4- and 9-11-mo-old male and female rats treated with vehicle or a COX2 inhibitor during nephrogenic period (COX2np). Our data show that this COX2 inhibition induces an ANG II-dependent hypertension that is similar in male and female rats. Renal functional reserve is reduced in COX2np-treated rats since their renal response to an increase in plasma amino acids levels is abolished, and their renal ability to eliminate a sodium load is impaired (P < 0.05). This reduction in renal excretory ability is similar in both sexes during aging but does not induce the development of a sodium-sensitive hypertension. However, the prolonged high-sodium intake at 9-11 mo of age leads to a greater proteinuria in male than in female (114 ± 12 μg/min vs. 72 ± 8 μg/min; P < 0.05) COX2np-treated rats. Renal hemodynamic sensitivity to acute increments in ANG II is unaltered in both sexes and at both ages in COX2np-treated rats. In summary, these results indicate that the reduction of COX2 activity during nephrogenic period programs for the development of an ANG II-dependent hypertension, reduces renal functional reserve to a similar extent in both sexes, and increases proteinuria in males but not in females when there is a prolonged increment in sodium intake.
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Affiliation(s)
- Virginia Reverte
- Dept. of Physiology, School of Medicine, Univ. of Murcia, 30100 Murcia, Spain.
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Chen CY, Hsu TW, Mao SJT, Chang SC, Yang PC, Lee YC, Yang KY. Abnormal renal resistive index in patients with mild-to-moderate chronic obstructive pulmonary disease. COPD 2013; 10:216-25. [PMID: 23547633 DOI: 10.3109/15412555.2012.719051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Arterial rigidity and endothelial dysfunction are systemic manifestations of chronic obstructive pulmonary disease (COPD). The decrease in renal vascular resistance in order to adapt the increase in glomerular filtration rate after oral protein loading is known as normal renal functional reserve. We tested the hypothesis that COPD patients, even in those with mild-to-moderate airflow obstruction, are affected by systemic inflammation associated with abnormal renal functional reserve. MATERIALS AND METHODS The study enrolled 24 current smokers with a cigarette smoking history ≥ 25 pack-years and 8 nonsmokers with normal spirometry as control. Doppler sonography detected the renal resistive index (RRI) before and after oral protein loading to determine the renal functional reserve. Pulmonary function and serum tumor necrosis factor α (TNF-α) levels were analyzed to compare with the renal functional reserve. RESULTS The smokers were stratified into 3 groups (Group 1: smokers with normal spirometry, Group 2: mild COPD, Group 3: moderate COPD); nonsmokers as Group 4. The baseline RRI levels were similar in Group 1 and Group 4. After protein loading, the RRI elevated in all smoking groups; moreover, Group 3 had the highest RRI and with longer duration than other groups. The smokers with higher serum TNF-α levels had a longer RRI elevation. Multiple linear regression revealed forced expiratory volume in one second (FEV1), serum TNF-α levels and aging were independently predictive factors of impaired renal functional reserve. CONCLUSIONS A greater impairment in renal functional reserve of COPD patients was correlated with more severe airway obstruction and inflammation.
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Affiliation(s)
- Cheng-Yu Chen
- Section of Chest Medicine, Department of Internal Medicine, National Yang-Ming University Hospital, Ilan, Taiwan
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38
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Tebot I, Bonnet JM, Paquet C, Ayoub JY, Da Silva SM, Louzier V, Cirio A. The effect of intravenous insulin infusion on renal blood flow in conscious sheep is partially mediated by nitric oxide but not by prostaglandins1. J Anim Sci 2012; 90:1192-200. [DOI: 10.2527/jas.2011-4129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mirmiran P, Hajifaraji M, Bahadoran Z, Sarvghadi F, Azizi F. Dietary protein intake is associated with favorable cardiometabolic risk factors in adults: Tehran Lipid and Glucose Study. Nutr Res 2012; 32:169-76. [DOI: 10.1016/j.nutres.2012.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 12/12/2011] [Accepted: 01/13/2012] [Indexed: 01/16/2023]
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Turner JM, Bauer C, Abramowitz MK, Melamed ML, Hostetter TH. Treatment of chronic kidney disease. Kidney Int 2011; 81:351-62. [PMID: 22166846 DOI: 10.1038/ki.2011.380] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Treatment of chronic kidney disease (CKD) can slow its progression to end-stage renal disease (ESRD). However, the therapies remain limited. Blood pressure control using angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) has the greatest weight of evidence. Glycemic control in diabetes seems likely to retard progression. Several metabolic disturbances of CKD may prove to be useful therapeutic targets but have been insufficiently tested. These include acidosis, hyperphosphatemia, and vitamin D deficiency. Drugs aimed at other potentially damaging systems and processes, including endothelin, fibrosis, oxidation, and advanced glycation end products, are at various stages of development. In addition to the paucity of proven effective therapies, the incomplete application of existing treatments, the education of patients about their disease, and the transition to ESRD care remain major practical barriers to better outcomes.
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Affiliation(s)
- Jeffrey M Turner
- Nephrology Division, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
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Bilan VP, Salah EM, Bastacky S, Jones HB, Mayers RM, Zinker B, Poucher SM, Tofovic SP. Diabetic nephropathy and long-term treatment effects of rosiglitazone and enalapril in obese ZSF1 rats. J Endocrinol 2011; 210:293-308. [PMID: 21680617 DOI: 10.1530/joe-11-0122] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Diabetic nephropathy (DN) is a major cause of end-stage renal disease. Yet the pathogenic mechanisms underlying the development of DN are not fully defined, partially due to lack of suitable models that mimic the complex pathogenesis of renal disease in diabetic patients. In this study, we describe early and late renal manifestations of DN and renal responses to long-term treatments with rosiglitazone or high-dose enalapril in ZSF1 rats, a model of metabolic syndrome, diabetes, and chronic renal disease. At 8 weeks of age, obese ZSF1 rats developed metabolic syndrome and diabetes (hyperglycemia, glucosuria, hyperlipidemia, and hypertension) and early signs of renal disease (proteinuria, glomerular collagen IV deposition, tubulointerstitial inflammation, and renal hypertrophy). By 32 weeks of age, animals developed renal histopathology consistent with DN, including mesangial expansion, glomerulosclerosis, tubulointerstitial inflammation and fibrosis, tubular dilation and atrophy, and arteriolar thickening. Rosiglitazone markedly increased body weight but reduced food intake, improved glucose control, and attenuated hyperlipidemia and liver and kidney injury. In contrast, rosiglitazone markedly increased cardiac hypertrophy via a blood pressure-independent mechanism. High-dose enalapril did not improve glucose homeostasis, but normalized blood pressure, and nearly prevented diabetic renal injury. The ZSF1 model thus detects the clinical observations seen with rosiglitazone and enalapril in terms of primary and secondary endpoints of cardiac and renal effects. This and previous reports indicate that the obese ZSF1 rat meets currently accepted criteria for progressive experimental diabetic renal disease in rodents, suggesting that this may be the best available rat model for simulation of human DN.
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Affiliation(s)
- Victor P Bilan
- Division of Pulmonary, Allergy, and Critical Care Medicine, Vascular Medicine Institute, Departments of Medicine Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA
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Kjaergaard KD, Jensen JD, Peters CD, Jespersen B. Preserving residual renal function in dialysis patients: an update on evidence to assist clinical decision making. NDT Plus 2011; 4:225-30. [PMID: 25949486 PMCID: PMC4421450 DOI: 10.1093/ndtplus/sfr035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 02/28/2011] [Indexed: 12/29/2022] Open
Abstract
It has been documented that preservation of residual renal function in dialysis patients improves quality of life as well as survival. Clinical trials on strategies to preserve residual renal function are clearly lacking. While waiting for more results from clinical trials, patients will benefit from clinicians being aware of available knowledge. The aim of this review was to offer an update on current evidence assisting doctors in clinical practice.
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Affiliation(s)
- Krista Dybtved Kjaergaard
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark ; Institute of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - Jens Dam Jensen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark ; Institute of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - Christian Daugaard Peters
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark ; Institute of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - Bente Jespersen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark ; Institute of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
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Herlitz LC, Markowitz GS, Farris AB, Schwimmer JA, Stokes MB, Kunis C, Colvin RB, D'Agati VD. Development of focal segmental glomerulosclerosis after anabolic steroid abuse. J Am Soc Nephrol 2010; 21:163-72. [PMID: 19917783 PMCID: PMC2799287 DOI: 10.1681/asn.2009040450] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Accepted: 09/17/2009] [Indexed: 11/03/2022] Open
Abstract
Anabolic steroid abuse adversely affects the endocrine system, blood lipids, and the liver, but renal injury has not been described. We identified an association of focal segmental glomerulosclerosis (FSGS) and proteinuria in a cohort of 10 bodybuilders (six white and four Hispanic; mean body mass index 34.7) after long-term abuse of anabolic steroids. The clinical presentation included proteinuria (mean 10.1 g/d; range 1.3 to 26.3 g/d) and renal insufficiency (mean serum creatinine 3.0 mg/dl; range 1.3 to 7.8 mg/dl); three (30%) patients presented with nephrotic syndrome. Renal biopsy revealed FSGS in nine patients, four of whom also had glomerulomegaly, and glomerulomegaly alone in one patient. Three biopsies revealed collapsing lesions of FSGS, four had perihilar lesions, and seven showed > or =40% tubular atrophy and interstitial fibrosis. Among eight patients with mean follow-up of 2.2 yr, one progressed to ESRD, the other seven received renin-angiotensin system blockade, and one also received corticosteroids. All seven patients discontinued anabolic steroids, leading to weight loss, stabilization or improvement in serum creatinine, and a reduction in proteinuria. One patient resumed anabolic steroid abuse and suffered relapse of proteinuria and renal insufficiency. We hypothesize that secondary FSGS results from a combination of postadaptive glomerular changes driven by increased lean body mass and potential direct nephrotoxic effects of anabolic steroids. Because of the expected rise in serum creatinine as a result of increased muscle mass in bodybuilders, this complication is likely underrecognized.
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Affiliation(s)
| | | | - Alton B. Farris
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joshua A. Schwimmer
- Medicine, Columbia University, College of Physicians and Surgeons, New York, New York
- Department of Medicine, Lenox Hill Hospital, New York, New York; and
| | | | - Cheryl Kunis
- Medicine, Columbia University, College of Physicians and Surgeons, New York, New York
| | - Robert B. Colvin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Wang YF, Yancy WS, Yu D, Champagne C, Appel LJ, Lin PH. The relationship between dietary protein intake and blood pressure: results from the PREMIER study. J Hum Hypertens 2008; 22:745-54. [PMID: 18580887 DOI: 10.1038/jhh.2008.64] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Observational and clinical studies suggest that high protein intake, particularly protein from plant sources, might reduce blood pressure (BP). To examine the association of dietary protein with BP, we analysed data from PREMIER, an 18-month clinical trial (n=810) that examined the effects of two multi-component lifestyle modifications on BP. We examined the association of protein intake with BP, and in particular the independent relationship of plant and animal protein with BP. Multivariable linear regression analyses were performed with both cross-sectional and longitudinal data. Dietary plant protein was inversely associated with both systolic and diastolic BP in cross-sectional analyses at the 6-month follow-up (P=0.0045 and 0.0096, respectively). Fruit and vegetable intake was also inversely associated with both systolic and diastolic BP cross-sectionally at 6 months (P=0.0003 and 0.0157, respectively). In longitudinal analyses, a high intake of plant protein at 6 months was marginally associated with a reduction of both systolic and diastolic BP from baseline to 6 months only (P=0.0797 and 0.0866, respectively), independent of change in body weight and waist circumference. Furthermore, increased intake of plant protein, and fruits and vegetables was significantly associated with a lower risk of hypertension at 6 but not at 18 months. Results of this study indicate that plant protein had a beneficial effect on BP and was associated with a lower risk of hypertension at 6 months. Our data, in conjunction with other research, suggest that an increased intake of plant protein may be useful as a means to prevent and treat hypertension.
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Affiliation(s)
- Y F Wang
- Health and Productivity Management Program, Society of Health Risk Assessment and Control, Chinese Association of Preventive Medicine, 1202 Fortune International Center, Haidian District, Beijing, China.
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Griffin KA, Kramer H, Bidani AK. Adverse renal consequences of obesity. Am J Physiol Renal Physiol 2008; 294:F685-96. [PMID: 18234955 DOI: 10.1152/ajprenal.00324.2007] [Citation(s) in RCA: 185] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Emerging evidence indicates that obesity, even in the absence of diabetes, contributes significantly to the development and progression of chronic kidney disease (CKD). Glomerular hyperfiltration/hypertrophy in response to the increased metabolic needs of obesity are postulated to lead to the development of glomerulosclerosis (GS) in a manner analogous to that in reduced renal mass states. Nevertheless, the individual risk for developing GS with obesity is very low. It is proposed that glomerular hyperfiltration/hypertrophy are per se not pathogenic in the absence of an enhanced glomerular blood pressure (BP) transmission, and the modest preglomerular vasodilation that is likely present in the large majority of obese individuals is not sufficient to result in such increased BP transmission. However, in the small subset of obese individuals who are also born with a substantially reduced nephron number, there is a greater risk of enhanced glomerular BP transmission due to the substantially greater preglomerular vasodilation. Of perhaps greater clinical importance, similar additive deleterious effects of obesity on BP transmission would be expected in individuals with reduced renal mass, either congenital or acquired, or with concurrent renal disease, leading to accelerated progression. Of note, a low birth weight may be a risk factor for not only reduced nephron numbers at birth, but also for obesity and hypertension, resulting in a clustering of risk factors for progressive GS. Therefore, even though the individual risk for developing obesity GS is low, the cumulative impact of obesity on the public health burden of CKD is likely to be large because of its huge prevalence.
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Affiliation(s)
- Karen A Griffin
- Loyola Univ. Medical Center, 2160 South First Ave., Maywood, IL 60153, USA.
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Loria A, Reverte V, Salazar F, Saez F, Llinas MT, Salazar FJ. Changes in renal hemodynamics and excretory function induced by a reduction of ANG II effects during renal development. Am J Physiol Regul Integr Comp Physiol 2007; 293:R695-700. [PMID: 17491111 DOI: 10.1152/ajpregu.00191.2007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim was to evaluate whether blockade of ANG II effects during renal development modifies the renal response to an increment of plasma amino acid concentration. It was also examined in anesthetized rats whether the reduction of the renal ability to eliminate an acute volume expansion (VE), elicited by blockade of ANG II during renal development, is sex and/or age dependent. Newborn Sprague-Dawley rats were treated with vehicle or an AT(1)-receptor antagonist (ARA) during postnatal nephrogenesis. Amino acid infusion induced increments (P < 0.05) of glomerular filtration rate (31 +/- 6%) and renal plasma flow (26 +/- 5%) in male but not in female vehicle-treated rats. Natriuretic and diuretic responses to amino acid infusion were similar in male and female vehicle-treated rats. These renal hemodynamics and excretory responses to amino acid infusion were abolished in ARA-treated rats. Renal responses to VE were evaluated at 3-4 and 9-10 mo of age in vehicle and ARA-treated rats. VE-induced natriuresis and diuresis were reduced by more than 38% (P < 0.05) in 3- to 4-mo-old male and female ARA-treated rats. An age-dependent reduction (P < 0.05) in the renal ability to eliminate VE was found in male but not in female rats treated with ARA. Our results demonstrate that the renal effects induced by an increment in amino acids are abolished when ANG II effects have been reduced during nephrogenesis. In addition, this reduction of ANG II effects elicits an impairment of the renal ability to eliminate an acute VE in males and females, which is aggravated by age only in male rats.
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Affiliation(s)
- Analia Loria
- Department of Physiology, School of Medicine, University of Murcia, 30100 Murcia, Spain
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Sakamoto M, Akehi Y, Mimura G, Tanaka M, Ohshita T, Yano M, Ishimaru Y, Ono J. The suppressive effects of dietary protein restriction on the progression of renal impairment in OLETF rats. Clin Exp Nephrol 2006; 10:244-52. [PMID: 17186328 DOI: 10.1007/s10157-006-0434-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Accepted: 08/08/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND The suppressive effect of dietary protein restriction on the progression of diabetic nephropathy remains controversial. We investigated the effects of protein and energy restrictions on both albuminuria and morphology using diabetic-prone Otsuka Long-Evans Tokushima fatty (OLETF) rats. METHODS In this study, male OLETF rats were divided into two groups according to their energy intake. They were then further divided into three subgroups based on their amount of dietary protein, which ranged between 10% and 30% of their total intake. Urinary albumin excretion (UAE) was used as a marker of renal impairment, and body weight fasting (F) and postchallenge (P), blood glucose (BG) levels, and systolic blood pressure (SBP) were all measured during various experimental periods up to 28 weeks of age. RESULTS The OLETF rats fed with the high-calorie diet started to gain weight at 12 weeks, and their FBG and PBG were elevated at 22 weeks, while SBP did not differ between the two groups. In addition, UAE increased significantly in the rats fed with the high-calorie diet. However, the increasing rates of UAE with age were higher in the rats with a higher protein diet within the same energy groups. UAE correlated well with the amounts of dietary energy and protein at 16 and 28 weeks of age, while it correlated with both the FBG and PBG at only 28 weeks of age. A linear regression analysis, using the data obtained at 28 weeks, showed that the amount of protein intake and FBG explained 63.4% and 23.9% of the variation in UAE, respectively. Histological studies revealed that protein and energy restriction markedly reduced the sclerotic changes of the glomeruli. CONCLUSION Dietary protein restriction starting very early in the life of OLETF rats, in combination with energy restriction, clearly suppressed UAE and the typical morphological changes that otherwise occurred at around 16 weeks of age. This method also seemed to be more effective than energy restriction alone in slowing down any increase in UAE. The influence of BG levels on UAE was lower at an early age, while it became an increasingly important factor at later ages in the experimental rat model.
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Affiliation(s)
- Miyoko Sakamoto
- Department of Laboratory Medicine, School of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
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Gibson KJ, Boyce AC, Karime BM, Lumbers ER. Maternal renal insufficiency alters plasma composition and renal function in the fetal sheep. Am J Physiol Regul Integr Comp Physiol 2006; 292:R1204-11. [PMID: 17068164 DOI: 10.1152/ajpregu.00188.2006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To determine the effects of chronic maternal renal insufficiency on fetal renal function, we studied nine fetuses whose mothers underwent subtotal nephrectomy at least 2 mo before mating (STNxF) and seven fetuses from intact ewes (IntF) (126-128 days of gestation, term 150 days). STNxF had lower hematocrit (P < 0.05), plasma chloride (P < 0.01), and creatinine levels (P < 0.01), and the length-to-width ratio of their kidneys was reduced (P < 0.05). They excreted twice as much urine (P < 0.05) and sodium (P < 0.01). Total (P = 0.01) and proximal fractional sodium reabsorptions (P < 0.05) were lower in STNxF; distal delivery of sodium (P < 0.05) and distal fractional sodium reabsorption (P < 0.05) were higher. They tended to have suppressed renin levels (P = 0.06). Infusions of amino acids (alanine, glycine, proline, and serine at 0.32 mmol/min for 1 h and 0.64 mmol/min for 2 h intravenously), known to stimulate renal blood flow and glomerular filtration rate in fetal sheep, did so in IntF (P < 0.01). Arterial pressure also increased (P < 0.01). These effects were not observed in STNxF. In summary, chronic maternal renal insufficiency was associated with profound alterations in fetal renal excretion of fluid and electrolytes and impaired renal hemodynamic and glomerular responses to amino acid infusion. Whether these marked changes in the renal function of fetuses carried by STNx ewes are associated with alterations in renal function in postnatal or adult life remains to be determined.
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Affiliation(s)
- Karen J Gibson
- Department of Physiology and Pharmacology, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia.
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Yao B, Xu J, Qi Z, Harris RC, Zhang MZ. Role of renal cortical cyclooxygenase-2 expression in hyperfiltration in rats with high-protein intake. Am J Physiol Renal Physiol 2006; 291:F368-74. [PMID: 16597606 DOI: 10.1152/ajprenal.00500.2005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Renal cortical cyclooxygenase-2 (COX-2) is restricted to the macula densa and adjacent cortical thick ascending limbs (MD/cTALH). Renal cortical COX-2 increases in response to diabetes and renal ablation, both of which are characterized by hyperfiltration and reduced NaCl delivery to the MD due to increased proximal NaCl reabsorption. High-protein intake also induces hyperfiltration and decreases NaCl delivery to the MD due to increased NaCl reabsorption proximally. We investigated whether high protein induces cortical COX-2 and whether cortical COX-2 contributes to high protein-induced hyperfiltration and increased intrarenal renin biosynthesis. Cortical COX-2 increased after protein loading but decreased after protein restriction. COX-2 inhibition attenuated high protein-induced hyperfiltration but had no effect on high protein-induced intrarenal renin elevation. Therefore, induction of cortical COX-2 contributed to high protein-induced hyperfiltration but not intrarenal renin elevation. In the kidney cortex, neuronal nitric oxide synthase (nNOS) is also localized to the MD, and interactions between intrarenal nNOS and COX-2 systems have been proposed. Cortical COX-2 elevation seen in salt restriction was blocked by nNOS inhibiton. Cortical nNOS expression also increased after protein loading, and inhibition of nNOS activity completely reversed high protein-induced cortical COX-2 elevation and hyperfiltration. These results indicate that NO is a mediator of high protein-induced cortical COX-2 elevation and suggest that both intrarenal nNOS and COX-2 systems appear to regulate afferent arteriolar tone and subsequent hyperfiltration seen in high-protein intake.
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Affiliation(s)
- Bing Yao
- Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-2372, USA
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Pfeil K, Staudacher T, Luippold G. Effect of L-Dopa Decarboxylase Inhibitor Benserazide on Renal Function in Streptozotocin-Diabetic Rats. Kidney Blood Press Res 2006; 29:43-7. [PMID: 16636577 DOI: 10.1159/000092849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2005] [Accepted: 12/22/2005] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND/AIMS Benserazide (BZD), an inhibitor of the dopamine synthesis, abolished the increase in glomerular filtration rate (GFR) following the infusion of a mixed amino acid solution. These results reveal endogenous dopamine as a mediator in the renal response to amino acids. The aim of the present study was to evaluate whether dopamine is also involved in the regulation of glomerular hyperfiltration during the early state of diabetes mellitus (DM). METHODS Male Sprague-Dawley rats were injected with a single dose of streptozotocin (60 mg/kg i.p.) for induction of experimental DM (n = 7-8/group). Age-matched non-diabetic animals, injected with citrate buffer, served as controls (CON, n = 8/group). Clearance experiments were performed 2 weeks after induction of DM in thiopental-anesthetized rats (80 mg/kg i.p.), which were continuously infused either with BZD (30 microg/min/kg) or vehicle (VHC). RESULTS Mean arterial blood pressure was around 110 mm Hg and did not significantly differ among the groups. GFR was 0.95 +/- 0.02 ml/min/100 g b.w. in VHC-treated CON. BZD treatment did not significantly change GFR in the CON group (0.92 +/- 0.06 ml/min/100 g b.w.). As expected, glomerular hyperfiltration was observed in diabetic rats infused with VHC (1.24 +/- 0.08 ml/min/100 g b.w.). Treatment with BZD significantly reduced the diabetes-induced increase in GFR to control levels (0.95 +/- 0.05 ml/min/100 g b.w.). CONCLUSION Our results show that the inhibition of dopamine synthesis prevented the increase in GFR due to diabetic conditions, indicating that endogenous dopamine is involved in the regulation of DM-induced changes in renal hemodynamics.
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Affiliation(s)
- Katrin Pfeil
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Tübingen, Tübingen, Germany
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