scholarly journals Extracellular phosphate sensing in mammals: what do we know?

2020 ◽  
Vol 65 (3) ◽  
pp. R53-R63 ◽  
Author(s):  
Laurent Beck ◽  
Sarah Beck-Cormier
Keyword(s):  
Fibroblast Growth Factor 23 ◽  
Critical Role ◽  
The Body ◽  
Disease States ◽  
Calcium Sensing ◽  
Phosphate Sensing ◽  
Life Threatening ◽  
Body Level ◽  
Stage Renal Disease ◽  
End Stage

The critical role of phosphate (Pi) in countless biological processes requires the ability to control its concentration both intracellularly and extracellularly. At the body level, this concentration is finely regulated by numerous hormones, primarily parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23). While this control of the body’s Pi homeostasis is now well documented, knowledge of the mechanisms that allow the cell and the body to detect extracellular Pi variations is much less known. These systems are well described in bacteria, yeasts and plants, but as will be discussed in this review, knowledge obtained from these organisms is not entirely relevant to the requirements of Pi biology in mammals. In this review, we present the latest findings on extracellular Pi sensing in mammals, and describe the mammalian Pi sensors identified to date, such as SLC20A1 (PIT1)/SLC20A2 (PIT2) heterodimers and the calcium-sensing receptor (CaSR). While there are many questions remaining to be resolved, a clarification of the Pi sensing mechanisms in mammals is critical to understanding the deregulation of Pi balance in certain life-threatening disease states, such as end-stage renal disease and associated vascular calcifications, and to proposing relevant therapeutic approaches.

scholarly journals Ifosfamide May Be Safely Used in Patients with End Stage Renal Disease on Hemodialysis

Sarcoma ◽  
2009 ◽  
Vol 2009 ◽  
pp. 1-5 ◽  
Author(s):  
Sheron Latcha ◽  
Robert G. Maki ◽  
Gary K. Schwartz ◽  
Carlos D. Flombaum
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Response To Therapy ◽  
Common Side Effect ◽  
Pharmacokinetic Data ◽  
Life Threatening ◽  
Stage Renal Disease ◽  
End Stage ◽  
Metastatic Sarcoma ◽  
Radiographic Improvement

Background. Pharmacokinetic data on clearance of ifosfamide in hemodialysis patients are limited. Consequently, these patients are excluded from therapy with this agent. We review the outcomes for patients at our institution with end stage renal disease on dialysis who received ifosfamide for metastatic sarcoma.Patients and Methods. We treated three patients with end stage renal disease on hemodialysis with escalating doses of ifosfamide. Data on radiographic response to therapy, WBC and platelet counts, signs or symptoms of infection, neuropathy and bladder toxicity are reported. Starting doses of ifosfamide were based on review of the literature available with subsequent modifications based on each patient's prior exposure to myelosuppressive agents and on symptoms of neurotoxicity and the degree of myelosuppression following each cycle of chemotherapy.Results. Myelosuppression was the most common side effect from therapy, but no patient developed a life threatening infection, neurotoxicity, or hematuria. One patient developed epistaxis in the setting of thrombocytopenia while on warfarin therapy. All patients had clinical evidence for therapeutic response and two had documented radiographic improvement following ifosfamide administration.Conclusion. Ifosfamide can be used safely in combination with hemodialysis in patients with end stage renal disease.

scholarly journals The Pathogenesis of End-Stage Renal Disease from the Standpoint of the Theory of General Pathological Processes of Inflammation

2021 ◽  
Vol 22 (21) ◽  
pp. 11453
Author(s):  
Evgenii Gusev ◽  
Liliya Solomatina ◽  
Yulia Zhuravleva ◽  
Alexey Sarapultsev
Keyword(s):  
Kidney Disease ◽  
Renal Disease ◽  
Chronic Renal Disease ◽  
Classical Type ◽  
Low Grade ◽  
Systemic Complications ◽  
Life Threatening ◽  
Microcirculatory Disorders ◽  
Stage Renal Disease ◽  
End Stage

Chronic kidney disease can progress to end-stage chronic renal disease (ESRD), which requires the use of replacement therapy (dialysis or kidney transplant) in life-threatening conditions. In ESRD, irreversible changes in the kidneys are associated with systemic changes of proinflammatory nature and dysfunctions of internal organs, skeletal muscles, and integumentary tissues. The common components of ESRD pathogenesis, regardless of the initial nosology, are (1) local (in the kidneys) and systemic chronic low-grade inflammation (ChLGI) as a risk factor for diabetic kidney disease and its progression to ESRD, (2) inflammation of the classical type characteristic of primary and secondary autoimmune glomerulonephritis and infectious recurrent pyelonephritis, as well as immune reactions in kidney allograft rejection, and (3) chronic systemic inflammation (ChSI), pathogenetically characterized by latent microcirculatory disorders and manifestations of paracoagulation. The development of ChSI is closely associated with programmed hemodialysis in ESRD, as well as with the systemic autoimmune process. Consideration of ESRD pathogenesis from the standpoint of the theory of general pathological processes opens up the scope not only for particular but also for universal approaches to conducting pathogenetic therapies and diagnosing and predicting systemic complications in severe nephropathies.

scholarly journals Cardiac Arrest Secondary to Bilateral Pulmonary Emboli following Arteriovenous Fistula Thrombectomy: A Case Report with Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Avni Shah ◽  
Naheed Ansari ◽  
Zaher Hamadeh
Keyword(s):  
Cardiac Arrest ◽  
Arteriovenous Fistula ◽  
Pulmonary Emboli ◽  
Hemodialysis Access ◽  
Number Of Patients ◽  
Life Threatening ◽  
Timely Fashion ◽  
Pulmonary Embolization ◽  
Stage Renal Disease ◽  
End Stage

Number of patients with End Stage Renal Disease (ESRD) is growing worldwide. Hemodialysis remains the main modality of renal replacement therapy for ESRD patients. A patent hemodialysis access (arteriovenous fistula or arteriovenous graft) plays a key role in successful delivery of hemodialysis. Common vascular access issues encountered by patients and nephrologists are thrombosis and infection. The thrombosed access is declotted by various percutaneous techniques these days by multiple outpatient access centers in a timely fashion. Thrombolysis can give rise to various complications, a few of which can be life threatening. A young hemodialysis patient underwent percutaneous thrombolysis of his clotted arteriovenous fistula. Outpatient access thrombectomy was complicated immediately afterwards with cardiac arrest requiring cardiac resuscitation in the recovery room. The patient was admitted to intensive care unit after life sustaining care. Work up revealed multiple pulmonary emboli to both lung fields on CT scan of the chest. Patient was anticoagulated and discharged from the hospital. Thrombolysis of clotted hemodialysis access is associated commonly with occurrences of pulmonary embolic which are usually asymptomatic. Massive pulmonary embolization due to access thrombolysis is rare. Nephrologists and radiologists should be aware of this dangerous complication particularly in patients with preexisting cardiopulmonary disease.

Staphylococcus-induced glomerulonephritis: potential role for corticosteroids

2021 ◽  
Vol 14 (1) ◽  
pp. e237011
Author(s):  
Rui Filipe Nogueira ◽  
Nuno Oliveira ◽  
Vítor Sousa ◽  
Rui Alves
Keyword(s):  
Kidney Function ◽  
Potential Role ◽  
Graft Infection ◽  
Clinical Manifestations ◽  
Rapidly Progressive Glomerulonephritis ◽  
Vascular Graft Infection ◽  
Systemic Corticosteroids ◽  
Life Threatening ◽  
Stage Renal Disease ◽  
End Stage

Staphylococcus aureus is a troublesome pathogen, responsible for a broad range of clinical manifestations, ranging from benign skin infections to life-threatening conditions such as endocarditis and osteomyelitis. The kidney can be affected through a rapidly progressive glomerulonephritis mediated by an inflammatory reaction against a superantigen deposited in the glomerulus during the infection’s course. This glomerulopathy has a poor prognosis, often leading to chronically impaired kidney function, eventually progressing to end-stage renal disease. Treatment rests on antibiotherapy. Despite the inflammatory role in this disease’s pathophysiology, most authors discourage a simultaneous immunosuppressive approach given the concomitant infection. However, there are some reports of success after administration of systemic corticosteroids in these patients. We present a 66-year-old man with a staphylococcus-induced glomerulonephritis brought on by a vascular graft infection, with rapidly deteriorating kidney function despite extraction of the infected graft and 3 weeks of antibiotherapy with achievement of infection control. Kidney function improved after the introduction of corticosteroids. This case highlights the potential role of corticosteroids in selected cases of staphylococcus-induced glomerulonephritis, particularly those in which the infection is under control.

La diagnosi precoce di malattia

2019 ◽  
Vol 31 (1) ◽  
pp. 58-60
Author(s):  
Federica Rossi ◽  
Federico Pieruzzi
Keyword(s):  
Wide Spectrum ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
The Body ◽  
Lysosomal Storage ◽  
Cerebrovascular Complications ◽  
Risk Patients ◽  
Alpha Galactosidase ◽  
Stage Renal Disease ◽  
End Stage

Anderson-Fabry disease is an X-linked, lysosomal, storage disorder characterized by the decreased activity of alpha-Galactosidase A, which results in accumulation of globotriaosylceramide (Gb-3) in cells and tissues throughout the body, leading to a wide spectrum of clinical manifestations. Patients are often misdiagnosed or diagnosed late in their life. This is due to the phenotypic heterogeneity, the poor awareness of this rare disease, and many pitfalls when making a differential diagnosis, in adulthood, as well as in the early stages. Delayed diagnosis has significant clinical implications, because the progression of the disease over time can lead to irreversible end-stage renal disease and life-threatening cardiovascular or cerebrovascular complications. Early diagnosis remains essential in order to start an early treatment and reduce the progression of the disease, thus maximizing the chance to improve patient outcomes. Newborn screening, high-risk patients’ identification, and increasing pediatricians’ and clinicians’ knowledge on this condition, are good strategies to avoid late referrals of Anderson-Fabry patients to reference centers.

Peritoneal Dialysis in Japan: The Issue of Encapsulating Peritoneal Sclerosis and Future Challenges

2005 ◽  
Vol 25 (4_suppl) ◽  
pp. 77-82 ◽  
Author(s):  
Akira Saito
Keyword(s):  
Peritoneal Dialysis ◽  
Treatment Modalities ◽  
Bacterial Peritonitis ◽  
Abdominal Bleeding ◽  
Dialysis Solution ◽  
Future Challenges ◽  
The Face ◽  
Life Threatening ◽  
Stage Renal Disease ◽  
End Stage

Encapsulating peritoneal sclerosis (EPS) is a life-threatening complication of peritoneal dialysis (PD). The overall prevalence of EPS in Japanese PD patients is 2.3%. Among patients on PD for less than 5 years, the rate is 0.9%; among patients on PD for 5 – 10 years, the rate is 3.8%; and among patients on PD for >10 years, it is 11.5%. Thus, the longer the treatment duration, the higher the prevalence of EPS. Encapsulating peritoneal sclerosis does not result solely from the natural progression of peritoneal sclerosis. A “second hit” event, such as bacterial peritonitis, abdominal bleeding, or abdominal surgery may be needed to trigger the onset of EPS in the face of advanced peritoneal sclerosis. To prevent development of EPS, PD treatment is replaced by other treatments when patients reached high-transport status. Peritoneal lavage and prednisolone administration have been reported to be effective in preventing or stopping the progress of EPS. When bowel obstruction has occurred, total enterolysis to remove the fibrous capsule from the bowel is indicated. To maximize overall quality of life, patients with end-stage renal disease (ESRD) should have the choice to make use of all the treatment modalities available: PD, hemodialysis (HD), and transplantation. Furthermore, the development of truly biocompatible PD equipment—including peritoneal catheters, solutions, and systems—are desirable to extend PD treatment for the long term. The cost of individual products could decrease significantly if PD use were to increase to 30% from 10% among ESRD patients worldwide. As practitioners, we have to further improve the technical survival rate and functional duration of PD treatment so that adequate peritoneal function can be maintained for 10 years in at least 40% of PD patients. The goal is to place PD on par with HD using high-flux dialysis membranes and ultrapure dialysis solution.

Geometric Enhancements of an Arteriovenous Graft

2009 ◽  
Author(s):  
Stephen P. Broderick ◽  
Gráinne Carroll ◽  
Micheal Walsh
Keyword(s):  
United States ◽  
The Elderly ◽  
The United States ◽  
Cost Of Care ◽  
The Body ◽  
Venous Anastomosis ◽  
And Migration ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

End Stage Renal Disease (ESRD) is the degeneration of kidney function to remove uremic toxins from the blood. Currently there are over 484,000 sufferers of ESRD in the United States, with this figure predicted to rise to over 800,000 by 2020 [1]. The total cost of care for patients with ESRD was estimated to exceed 1 billion dollars in the United States [2]. A kidney transplant is the ideal solution for ESRD patients; however with the increasing number of ESRD patients the odds of receiving a donor kidney are poor. The alternative is hemodialysis. This process is involves the extraction of blood from the patient to an extracorporal machine. Blood is pumped at a rate of 350 mL/min to ensure effective dialysis. The blood is then returned to the body cleaned. The gold standard for hemodialysis access is the native arteriovenous fistula [3] with the most common type being the Brescia-Cimino fistula at the wrist [4]. In some subgroups the fistula performs poorly. In diabetics and the elderly, specifically over 70s [2] or can’t be constructed because of unsuitable blood vessels [5]. In this case an alternative is the synthetic AV graft. Made of polytetrafluoroethelyne, it has lower patency rates against the fistula [6] [7] mediated by the susceptibility to thrombosis induced by stenosis development and infection [7].The majority of stenosis development is within the venous anastomosis (kanterman1995). The formation of intimal hyperplasia (IH) leading to stenosis formation is caused by smooth cell proliferation and migration as a result of endothelial cells reacting to shear stress receptors. The development of IH has been linked to local hemodynamics and turbulence in the flow, which in turn are heavily influenced by the geometry of the graft.

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