P0435PREDICTORS OF RENAL SURVIVAL IN ELDERLY NEPHROTIC SYNDROME

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Tasnim Ben ayed ◽  
Imen Gorsane ◽  
Raja Trabelsi ◽  
Mondher Ounissi ◽  
Taieb Ben Abdallah
Keyword(s):  
Nephrotic Syndrome ◽  
Membranous Nephropathy ◽  
Treatment Strategies ◽  
The Elderly ◽  
Albumin Level ◽  
Glomerular Disease ◽  
Renal Diseases ◽  
Renal Survival ◽  
Multivariate Study ◽  
The Mean

Abstract Background and Aims With increasing longevity, the numbers of elderly patients presenting with renal diseases including glomerular disease are increasing. Nephrotic syndrome (NS) is a common presentation of glomerular disease in the elderly. We performed this study to assess predictors of renal survival in this population. Method A retrospective study including one hundred and six patients aged 65 years or more hospitalized for NS in the Internal Medicine department A of Charles Nicolle hospital at Tunis, between January the 1st, 1975 and December the 31st, 2016. A multivariate study was carried out, the dependent variable being the evolution towards end-stage renal disease (ESRD). Results We studied 106 patients with an average age of 70 ± 4.5years [65-83 years] with a sex ratio (M/F) of 1.7. Twenty-three percent of patients were diabetic. The median proteinuria was 4.6 [3-19.5 g/l], the mean albumin level was 20 ± 5.6g/l and the mean protidemia was 50 ± 6.9 g/l. Nephrotic syndrome was impure in 89.6 % of patients with high blood pressure in 70.5 % of cases, hematuria ≥2 + in 34.7% of cases and renal failure in 88.4 % of cases. The renal biopsy was performed in 41 patients. The most common glomerular lesions were Membranous nephropathy (29 %) followed by amyloidosis (27 %). NS was secondary in 63.2 % of cases mainly to amyloidosis (35.8 %) and diabetes (19.8 %). Idiopathic nephropaty was dominated by membranous nephropathy (11.3 %) and primitive membranoproliferative glomerulonephritis (MPGN) (6.6 %). At the end of follow-up, 35 % of patients achieved complete or partial remission and 58.5 % progressed to ESRD. The multivariate study found as independent risk factors of progression to ESRD uremia ≥ 17 mmol/l (ORa =33.2 [1.3 - 837.7]; p<0.05), phosphoremia ≥ 1.6 mmol/l (ORa=22.1 [1.8-266.5]; p<0.05), potassium concentration ≥ 4.3mmol/l (ORa=24.7 [2.4,251.5]; p<0.01), extra-renal signs (ORa=38,9 [2.4 - 634.3]; p: 0.01), secondary nephropathy (ORa=74 [3.1 - 1788.2]; p<0.01) and MPGN (ORa=48[1.4 - 1675.5]; p<0.05). The protective factors were hemoglobinemia ≥ 9.3g/dl (ORa=0.007 [0 - 0.2]; p<0.01), kidneys well differentiated on ultrasound (ORa=0.032 [0.003 - 0.4]; p<0.01) and treatment with two diuretics (ORa=0.03 [0.003 - 0.4]; p<0.01). Conclusion Elderly NS was characterized by a poor prognosis, in particular secondary to delayed and non-uniform treatment strategies, hence the need for rising physician awarness about this decease and consultation on a standardized treatment strategies.

P0465NEPHROTIC SYNDROME IN ELDERLY PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Tasnim Ben ayed ◽  
Imen Gorsane ◽  
Raja Trabelsi ◽  
Mondher Ounissi ◽  
Taieb Ben Abdallah
Keyword(s):  
Nephrotic Syndrome ◽  
Membranous Nephropathy ◽  
Immunosuppressive Treatment ◽  
Treatment Strategies ◽  
The Elderly ◽  
Albumin Level ◽  
Study Objective ◽  
Multicentric Study ◽  
Glomerular Lesions ◽  
The Mean

Abstract Background and Aims Nephrotic syndrome (NS) is one of the manifestations of acute or chronic glomerular nephropathy in the elderly. Our study objective was to determine the particularities of NS in the elderly. Method This is a retrospective study, carried out in the Internal Medicine department A of Charles Nicolle hospital at Tunis, between January the 1st, 1975 and December the 31st, 2016. This study included subjects aged 65 years old or over hospitalized for NS. Results We studied 115 patients with an average age of 71 ± 5 years [65-83 years] with a sex ratio (M/F) of 1.7. Twenty-three percent of patients were diabetic. The median proteinuria was 4.7 g/l [3-19.5 g/l], the mean albumin level was 20 ± 6g/l and the mean protidemia was 50.6 ± 6.9 g/l. Nephrotic syndrome was impure in 89.5 % of patients with high blood pressure in 54 % of cases, hematuria ≥2 + in 30% of cases and renal failure in 82.7 % of cases. Renal biopsy was performed in 45 patients. The most common glomerular lesions were Membranous nephropathy (29 %) followed by amyloidosis (24.5 %). NS was secondary in 65.2 % of cases mainly to amyloidosis (35.6 %) and diabetes (19 %). Idiopathic nephropaty was dominated by membranous nephropathy (9.5 %) and primitive primitive (MPGN) (4.3 %). The treatment was symptomatic for 84.4% of patients. Corticosteroids and/or immunosuppressive treatment have been used for 15.6% of patients. At the end of follow-up, 35.3 % of patients achieved complete or partial remission and 56.6 % progressed to ESRD. Conclusion Elderly NS was characterized by a poor prognosis due to delayed cosultation and non-uniform treatment strategies. Multicentric study in order to identify different action axes could improve the prognosis of this disease. Multicentric study in order to identify different action axes could improve the prognosis of this disease.

scholarly journals Horseshoe kidney with PLA2R-positive membranous nephropathy

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shuai-Shuai Shi ◽  
Xian-Zu Yang ◽  
Xiao-Ye Zhang ◽  
Hui-Dan Guo ◽  
Wen-Feng Wang ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Renal Biopsy ◽  
Membranous Nephropathy ◽  
Horseshoe Kidney ◽  
Glomerular Disease ◽  
Urinary Stones ◽  
Abdominal Ultrasonography ◽  
Glomerular Diseases ◽  
Structural Abnormalities ◽  
Diagnosis Rate

Abstract Background Horseshoe kidney (HSK) is a common congenital defect of the urinary system. The most common complications are urinary tract infection, urinary stones, and hydronephrosis. HSK can be combined with glomerular diseases, but the diagnosis rate of renal biopsy is low due to structural abnormalities. There are only a few reports on HSK with glomerular disease. Here, we have reported a case of PLA2R-positive membranous nephropathy occurring in a patient with HSK. Case presentation After admission to the hospital due to oedema of both the lower extremities, the patient was diagnosed with nephrotic syndrome due to abnormal 24-h urine protein (7540 mg) and blood albumin (25 g/L) levels. Abdominal ultrasonography revealed HSK. The patient’s brother had a history of end-stage renal disease due to nephrotic syndrome. Therefore, the patient was diagnosed with PLA2R-positive stage II membranous nephropathy through renal biopsy under abdominal ultrasonography guidance. He was administered adequate prednisone and cyclophosphamide, and after 6 months of treatment, urinary protein excretion levels significantly decreased. Conclusion The risk and difficulty of renal biopsy in patients with HSK are increased due to structural abnormalities; however, renal biopsy can be accomplished through precise positioning with abdominal ultrasonography. In the literature, 20 cases of HSK with glomerular disease have been reported thus far. Because of the small number of cases, estimating the incidence rate of glomerular diseases in HSK is impossible, and the correlation between HSK and renal pathology cannot be stated. Further studies should be conducted and cases should be accumulated to elucidate this phenomenon.

scholarly journals The transcriptional regulation of Podocin (NPHS2) by Lmx1b and a promoter single nucleotide polymorphism

2009 ◽  
Vol 14 (4) ◽  
Author(s):  
Sigrid Harendza ◽  
Rolf Stahl ◽  
André Schneider
Keyword(s):  
Transcription Factor ◽  
Transcriptional Regulation ◽  
Nephrotic Syndrome ◽  
Focal Segmental Glomerulosclerosis ◽  
Membranous Nephropathy ◽  
Minimal Change ◽  
Renal Diseases ◽  
Single Nucleotide ◽  
Segmental Glomerulosclerosis ◽  
Minimal Change Glomerulonephritis

AbstractPodocin (NPHS2) is a component of the glomerular slit membrane with major regulatory functions in the renal permeability of proteins. A loss of podocin and a decrease in its resynthesis can influence the outcome of renal diseases with nephrotic syndrome, such as minimal change glomerulonephritis, focal segmental glomerulosclerosis (FSGS) and membranous nephropathy. The transcriptional regulation of podocin may play a major role in these processes. We defined the transcriptional regulation of the human podocin gene and the influence of single nucleotide polymorphisms (SNPs) within its promoter region in the podocytes using reporter gene constructs and gel shift analysis. In addition, we took genomic DNA from healthy Caucasian blood donors and from biopsies of kidneys with defined renal diseases and screened it for podocin promoter SNPs. Our data shows that the transcription of podocin is mainly regulated by the transcription factor Lmx1b, which binds to a FLAT-F element and displays enhancer function. With the SNP variant −116T, there was a significant reduction in luciferase activity, and nuclear protein binding was observed, while the SNP −670C/T did not display functionality. The allelic distribution of −116C/T in patients with kidney diseases leading to nephrotic syndrome was not significantly different from that in the control group. Our data indicates that among other factors, podocin is specifically regulated by the transcription factor Lmx1b and by the functional polymorphism -116C/T. However, there is no association between −116C/T and susceptibility to minimal change glomerulonephritis, focal segmental glomerulosclerosis or membranous nephropathy.

P0472RENAL OUTCOMES OF IDIOPATHIC MEMBRANOUS NEPHROPATHY IN ELDERLY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nessrine Breik ◽  
Mouna Jerbi ◽  
Raja Aoudia ◽  
Soumaya Chargui ◽  
Hanen Guaied ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Membranous Nephropathy ◽  
Older Patients ◽  
Symptomatic Treatment ◽  
Idiopathic Membranous Nephropathy ◽  
Angiotensin Receptors ◽  
Renal Survival ◽  
High Systolic Blood Pressure ◽  
Increased Risk ◽  
Significant Difference

Abstract Background and Aims Idiopathic membranous nephropathy (IMN) is increasingly seen in older patients but little is known about its treatment and outcomes at long term follow up. The objective of this work is to study the renal survival of IMN in elderly as well as prognostic factors. Method We conducted a retrospective descriptive study in the nephrology department at Charles Nicolle hospital over a period of 44 years. All older patients (≥65 years) with histologically proven MN were included in this study. Data collected included demographic, clinical and biological parameters in each patient. Data were entered and analyzed using SPSS software. Chi-squared test with a level of significance of 0.05 was used for the qualitative variables. Results Twenty-eight patients were collected. The mean age was 67.03 years (65-78 years) with a male predominance (sex ratio: 2.3) and low socio-economic level in 82.5% of cases. Sixteen patients were smokers (57.14%), 5 ethyl patients (17.8%), diabetes was present in 3 patients (10.7%) and hypertension in 11 patients (39.28%). The clinico-biological picture was dominated by high systolic blood pressure in 21 cases (75%), anasarca in 7 cases (25%), proteinuria in all cases and hematuria in 20 cases (71.14%). Biology revealed nephrotic syndrome (NS) in all cases, hypercholesterolemia in 23 cases (82.14%), high serum creatinine in 14 cases (50%) with an average creatinine level of 127,95 µmol/l, anemia in 17 cases (60.7%) and anti-neutrophil cytoplasmic antibodies were positive in one case. MN was confirmed by a kidney biopsy in all cases. Symptomatic treatment was indicated in all patients. Immunosuppressive therapy was started early in 12 patients (40%) because of the severe NS and the deterioration of renal function. Eight patients (26.6%) received corticosteroids alone, three patients received corticosteroid with mycofenolate mofetil and one patient received corticosteroid with ciclosporin. Fourteen patients received only symptomatic treatment. We noted complete remission in 6 patients (21.42%) and end renal stage disease in 5 patients (17.85%). Our study showed that treatment with angiotensin receptors blockers was associated with better renal survival with a statistically significant difference, (p = 0.011). A reduced kidney function at presentation, tubule-interstitial disease and interstitial fibrosis and tubular atrophy were associated with poor survival with a statistically significant result (p = 0.012) (p=0,011) respectively. Conclusion IMN is the most common cause of nephrotic syndrome in elderly patients and it has the same risk for progression as in younger individuals. Decrements in glomerular filtration rate, increased risk for comorbidities, vascular disease and change in pharmacokinetics justify special attention to treatment decisions in elderly individuals with IMN.

scholarly journals Relation between Renal Resistive Index and Serum Albumin in Nephrotic Syndrome

2021 ◽  
Vol 10 (30) ◽  
pp. 2228-2232
Author(s):  
Pranoy Dey ◽  
Niku Hage
Keyword(s):  
Nephrotic Syndrome ◽  
Serum Albumin ◽  
Serum Albumin Level ◽  
Left Kidney ◽  
Peak Systolic Velocity ◽  
Resistive Index ◽  
Albumin Level ◽  
Renal Resistive Index ◽  
The Mean ◽  
Renal Doppler

BACKGROUND Renal resistive index (RRI) is a non-invasive marker of renal function, which can be measured by renal USG Doppler. High RI indicates poor prognosis, which has been associated with conditions such as proteinuria, hypertension, chronic kidney disease and renal failure. As nephrotic syndrome is characterised by significant proteinuria and hypoalbuminemia, which may progress to renal failure, it is important to see the correlation of RRI with serum albumin level. The purpose of this study was to assess the relation between renal resistive index and serum albumin in nephrotic syndrome. METHODS USG renal Doppler was done for all the children with nephrotic syndrome and RRI was calculated as [(peak - systolic velocity − end - diastolic velocity) / peak - systolic velocity]. Blood investigations were also done, from which serum albumin values were obtained. RRI was compared with mean serum albumin level. Statistical analysis of data was performed using the computer programme, Statistical Package for Social Sciences (SPSS for windows, version 21.01, Chicago, SPSS Inc.) and Microsoft excel 2010. Results on continuous measurement were presented as mean ± standard deviation and compared using Analysis of Variance (ANOVA). RESULTS The mean serum albumin in the children with nephrotic syndrome in our study was 1.82 ± 0.32 gm / dl. The mean RI value was 0.66 ± 0.14 SD, 0.64 ± 0.15 SD and 0.66 ± 0.12 SD as well as 0.63 ± 0.12 SD, 0.67 ± 0.16 SD and 0.71 ± 0.13 SD on the right and left kidney respectively for each of upper, middle, and lower pole. P value of left kidney and right kidney was 0.0057 and 0.6409 respectively. CONCLUSIONS Lower the mean serum albumin level, higher the range of RRI. KEY WORDS Serum Albumin, Renal Resistive Index, Nephrotic Syndrome, USG Renal Doppler

Glomerular disease

2019 ◽  
pp. 213-258
Author(s):  
Lesley Rees ◽  
Nicholas J.A Webb ◽  
Detlef Bockenhauer ◽  
Marilynn G. Punaro
Keyword(s):  
Nephrotic Syndrome ◽  
Treatment Strategies ◽  
Glomerular Disease ◽  
Optimum Treatment ◽  
New Treatments

Understanding of the pathogenesis of nephrotic syndrome is rapidly increasing and new treatments are evolving. However, these diseases remain difficult to manage, with little evidence to help decide on optimum treatment strategies.

scholarly journals GLOMERULAR DISEASES IN MADINA REGION;

2019 ◽  
Vol 26 (04) ◽  
Author(s):  
Adil Manzoor ◽  
Imtiaz Bhatt ◽  
Rehan Javed
Keyword(s):  
Lupus Nephritis ◽  
Membranous Nephropathy ◽  
Minimal Change Disease ◽  
Epidemiological Data ◽  
Glomerular Disease ◽  
Renal Diseases ◽  
Glomerular Diseases ◽  
Thin Basement Membrane Nephropathy ◽  
Disease Patterns ◽  
Arabian Population

Objectives: The study is designed to get useful information and epidemiological data for clinical practice and investigations regarding glomerular disease frequencies in Madina region.  Study Design & Setting: Single-center retrospective study at King Fahd Hospital Madina. Period: 01 year (March 2016- March 2017). Methods: All native renal biopsies were studied for the period of 1 year (March 2016- March 2017). Only glomerular disease patterns were analyzed. The diagnosis of each case was based on histological, immunopathological and clinical features. Results: A total of 44 biopsies were Included. Primary glomerular diseases in 52.27% of all biopsies studied. The most common primary disease was Membranous Nephropathy which accounts for 20.45%. Focal and Segmental Glomerulosclerosis (FSGS) (9%), Minimal change disease (4.54%), C3 glomerulopathy  (4.54%), IGA Nephropathy (4.54%), Non-IgA Mesangial Proliferative GN(2.27%), Crescentic Glomerulonephritis (GN) (2.27%), Post lnfectlous GN(2.27%), Thin Basement Membrane Nephropathy(2.27%)  as primary GN. Secondary glomerular diseases in 47.73%. Lupus Nephritis corresponded to 34.09% of the entire series. Conclusions: FSGS has been the most frequent type of glomerulopathy in Saudi Arabian population according to previously available data from local studies but in our study the cases of Membranous Nephropathy were high .Lupus Nephritis remain above the list as a cause of secondary glomerular disease. The reasons for these findings are unclear but this information is an important contribution towards understanding the prevalence of renal diseases In Saudi Arabia.

Platelet Suruival and Function in Rats with Enhanced Thrombotic Tendency

1985 ◽  
Vol 54 (04) ◽  
pp. 739-743 ◽  
Author(s):  
Federica Delaini ◽  
Elisabetta Dejana ◽  
Ine Reyers ◽  
Elisa Vicenzi ◽  
Germana De Bellis Vitti ◽  
...  
Keyword(s):  
Arachidonic Acid ◽  
Nephrotic Syndrome ◽  
Platelet Function ◽  
Laboratory Tests ◽  
Thrombus Formation ◽  
The Other ◽  
Mean Survival Time ◽  
The Mean ◽  
And Function ◽  
Thrombotic Tendency

SummaryWe have investigated the relevance of some laboratory tests of platelet function in predicting conditions of thrombotic tendency. For this purpose, we studied platelet survival, platelet aggregation in response to different stimuli, TxB2 and 6-keto-PGFlα production in serum of rats bearing a nephrotic syndrome induced by adriamycin. These animals show a heavy predisposition to the development of both arterial and venous thrombosis. The mean survival time was normal in nephrotic rats in comparison to controls. As to aggregation tests, a lower aggregating response was found in ADR-treated rats using ADP or collagen as stimulating agents. With arachidonic acid (AA) we observed similar aggregating responses at lower A A concentrations, whereas at higher AA concentrations a significantly lower response was found in nephrotic rats, despite their higher TxB2 production. Also TxB2 and 6-keto-PGFlα levels in serum of nephrotic rats were significantly higher than in controls. No consistent differences were found in PGI2-activity generated by vessels of control or nephrotic rats.These data show that platelet function may appear normal or even impaired in rats with a markedly increased thrombotic tendency. On the other hand, the significance of high TxB2 levels in connection with mechanisms leading to thrombus formation remains a controversial issue.

The Development of Intelligence Walking Stick for Elderly Health Care using IoT

2020 ◽  
Vol 9 (5) ◽  
pp. 1334-1338
Keyword(s):  
Health Care ◽  
Daily Living ◽  
The Elderly ◽  
Mean Value ◽  
Real Time System ◽  
Pressure Oxygen ◽  
Elderly Health ◽  
The Mean ◽  
Iot Devices ◽  
Walking Stick

Nowadays, Thailand is stepping into an aging society. This research purposes developing the intelligence walking stick for the elderly in terms of the health care system by applied the IoT devices and biometric sensors in a real-time system. The heart rate, blood pressure, oxygen saturation, and temperature were measured at the finger of the elderly that holding the intelligence walking stick. All data can monitor and display on mobile devices. The intelligence walking stick system was evaluated by twenty users who are five experts and fifteen elderly in Ratchaburi province. As a result of the mean value at 4.88 and 4.85 by experts and elderly, respectively. It could be said that the development of intelligence walking stick by using IoT can help and improve the daily living of the elderly at the highest level.

Perspectives on the Therapeutic Benefits of Arginine Supplementation in Cancer Treatment

2019 ◽  
Vol 19 (7) ◽  
pp. 913-920
Author(s):  
Fabiani L. R. Beal ◽  
Pedro R. Beal ◽  
Juliana R. Beal ◽  
Natan Carvalho-Neves ◽  
Octávio L. Franco ◽  
...  
Keyword(s):  
Amino Acid ◽  
Side Effects ◽  
Cancer Treatment ◽  
Treatment Strategies ◽  
Endothelial Permeability ◽  
The Elderly ◽  
Therapeutic Benefits ◽  
Cell Growth And Differentiation ◽  
The Cost ◽  
Arginine Supplementation

Background: Arginine is considered a semi-essential amino acid in healthy adults and the elderly. This amino acid seems to improve the immune system, stimulate cell growth and differentiation, and increase endothelial permeability, among other effects. For those reasons, it has been theorized that arginine supplementation may be used as an adjuvant to conventional cancer therapy treatments. Objective: This review aims to evaluate the existing knowledge of the scientific community on arginine supplementation in order to improve the efficacy of current cancer treatment. Results: Despite the continued efforts of science to improve treatment strategies, cancer remains one of the greatest causes of death on the planet in adults and elderly people. Chemo and radiotherapy are still the most effective treatments but at the cost of significant side effects. Conclusion: Thus, new therapeutic perspectives have been studied in recent years, to be used in addition to traditional treatments or not, seeking to treat or even cure the various types of cancer with fewer side effects.

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