Clinical efficacy of adjuvant therapy with hyperbaric oxygen in diabetic nephropathy

2020 ◽  
pp. 415-430
Author(s):  
Karime Guadalupe Cardenas Ureña ◽  
◽  
Julio César Ramírez Nava ◽  
Félix Guillermo Márquez Celedonio ◽  
Omar Israel Salas Nolasco ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Relative Risk ◽  
Glomerular Filtration ◽  
Risk Reduction ◽  
Hyperbaric Oxygen ◽  
Filtration Rate ◽  
Clinical Stage ◽  
Ambient Air ◽  
Urinary Albumin ◽  
Control Group

Background and objective: Diabetic kidney disease (DKD) is the most common microvascular chronic complication of diabetes mellitus. Hyperbaric oxygen (HBO2) therapy will increase the partial pressure of oxygen (PaO2) and may improve cell repair processes, which can lead to better renal function. The objective of this study was to quantify the efficacy of adjuvant HBO2 to increase the glomerular filtration rate and urinary albumin excretion in diabetic patients, as well as determine its effectiveness to modify the clinical course of DKD. Materials and methods: An experimental study was performed on patients with stage 3 and 4 DKD. Twenty sessions of HBO2 or ambient air in a hyperbaric chamber were administered. Estimated glomerular filtration rate, urine albumin:creatinine ratio calculation and clinical stage stratification were made prior to and after HBO2 administration. A descriptive, inferential and clinical efficacy analysis was performed. Results: Urinary albumin/creatinine (UACR) mean values prior to HBO2 were 1452.9 ± 644.3 mg/g and decreased to 876.1 ± 504.0 mg/g at the end of the study (p=0.06). The patients in the control group showed a UACR mean of 2784.5 ± 2128.6 mg/g and 2861.4 ± 2424.2 mg/g at baseline and at the end of the study, respectively (p=0.82). Patients in the experimental/HBO2 group showed an estimated GFR of 27.3 ± 9.5 mL/min /1.73m2 before HBO2, with a 34.4 ± 6.9 mL/min/1.73m2 after treatment (p=0.017); control group eGFR was 30.1 ± 9.2 mL/min/1.73m2, decreasing to 22.2 ± 6.8 mL/min/1.73m2 (p=0.004). Relative risk 0.00, relative risk reduction -100%, absolute risk reduction -71.4%, 95% CI (-104.9% to -38.0%), NNT 1, 95% CI (1 to 3). Conclusions: Management with HBO2 for DKD was associated with decreased excretion urinary albumin, improved GFR and clinical stage of patients in stages 3 and 4 of kidney damage unlike those receiving ambient air.

scholarly journals Clinical Implications of the Change in Glomerular Filtration Rate with Adrenergic Blockers in Patients with Morning Hypertension: The Japan Morning Surge-1 Study

2013 ◽  
Vol 2013 ◽  
pp. 1-7
Author(s):  
Seiichi Shibasaki ◽  
Kazuo Eguchi ◽  
Yoshio Matsui ◽  
Kazuyuki Shimada ◽  
Kazuomi Kario
Keyword(s):  
Glomerular Filtration Rate ◽  
Treatment Group ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Early Stage ◽  
Urinary Albumin ◽  
Control Group ◽  
Ckd Stage ◽  
Negative Effect ◽  
Morning Hypertension

Background. The aim of this study was to clarify the relationship between the change in estimated glomerular filtration rate (eGFR) and urinary albumin by antihypertensive treatment.Methods. We randomized 611 treated patients with morning hypertension into either an added treatment group, for whom doxazosin was added to the current medication, or a control group, who continued their current medications. We compared the change in eGFR and urinary albumin creatinine ratio (UACR) between the groups.Results. The extent of the reduction in eGFR was significantly greater in the added treatment group than in the control group (−3.83  versus −1.08 mL/min/1.73 m2,P=0.001). In multivariable analyses, the change in eGFR was positively associated with the change in UACR in the added treatment group (β=0.20,P=0.001), but not in the control group (β=−0.002,P=0.97). When the changes in eGFR were divided by each CKD stage, eGFR was significantly more decreased in stage 1 than in the other stages in the added treatment group (P<0.001), but no differences were seen in the control group (P=0.44).Conclusion. The reduction of eGFR could be seen only in the early stage of CKD, and this treatment appeared to have no negative effect on renal function.

Effect of Proportional Reduction of Sodium Intake on the Adaptive Increase in Glomerular Filtration Rate/Nephron and Potassium and Phosphate Excretion in Chronic Renal Failure in the Rat

1975 ◽  
Vol 49 (3) ◽  
pp. 193-200 ◽  
Author(s):  
C. H. Espinel
Keyword(s):  
Renal Failure ◽  
Glomerular Filtration Rate ◽  
Chronic Renal Failure ◽  
Glomerular Filtration ◽  
Sodium Excretion ◽  
Filtration Rate ◽  
Sodium Intake ◽  
Dietary Sodium ◽  
Control Group ◽  
Phosphate Excretion

1. The influence of dietary sodium intake on the glomerular filtration rate (GFR/nephron) and potassium and phosphate excretion was examined at three stages of progressive chronic renal failure produced in rats by sequential partial nephrectomies. 2. The adaptive increased sodium excretion per nephron in the control group receiving a constant sodium intake did not occur in the experimental group that had a gradual reduction of dietary sodium in direct proportion to the fall in GFR. 3. Despite the difference in sodium excretion, the increase in GFR/nephron, the daily variation in the amount of potassium and phosphate excreted, the increase in potassium and phosphate excretion per unit nephron, and the plasma potassium and phosphate concentrations were the same in the two groups. 4. The concept of ‘autonomous adaptation’ in chronic renal failure is presented.

scholarly journals Chronic exposure to cadmium is associated with a marked reduction in glomerular filtration rate

2018 ◽  
Vol 12 (4) ◽  
pp. 468-475 ◽  
Author(s):  
Soisungwan Satarug ◽  
Kanyarat Boonprasert ◽  
Glenda C Gobe ◽  
Ronnatrai Ruenweerayut ◽  
David W Johnson ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Chronic Exposure ◽  
Filtration Rate ◽  
Positive Association ◽  
Population Based ◽  
Urinary Albumin ◽  
Cross Sectional ◽  
Men And Women ◽  
Albumin Excretion

Abstract Background Urinary 20-hydroxyeicosatetraenoic acid (20-HETE) has been associated with hypertension in women with elevated urinary cadmium (Cd) excretion rates. The present study investigates the urinary Cd and 20-HETE levels in relation to the estimated glomerular filtration rate (eGFR) and albumin excretion in men and women. Methods A population-based, cross-sectional study, which included 225 women and 84 men aged 33–55 years, was conducted in a rural area known to be polluted with Cd. Results In all subjects, lower eGFR values were associated with higher urinary Cd excretion (P = 0.030), and tubulopathy markers N-acetyl-β-d-glucosaminidase (P < 0.001) and β2-microglobulin (β2-MG) (P < 0.001). On average, the hypertensive subjects with the highest quartile of urinary Cd had eGFR values of 12 and 17 mL/min/1.73 m2 lower than that in the hypertensive (P = 0.009) and normotensive subjects (P < 0.001) with the lowest quartile of urinary Cd, respectively. In men, urinary albumin was inversely associated with 20-HETE (β = −0.384, P < 0.001), while showing a moderately positive association with systolic blood pressure (SBP) (β = 0.302, P = 0.037). In women, urinary albumin was not associated with 20-HETE (P = 0.776), but was associated with tubulopathy, reflected by elevated urinary excretion of β2-MG (β = 0.231, P = 0.002). Conclusions Tubulopathy is a determinant of albumin excretion in women, while 20-HETE and SBP are determinants of urinary albumin excretion in men. Associations of chronic exposure to Cd with marked eGFR decline and renal tubular injury seen in both Cd-exposed men and women add to mounting research data that links Cd to the risk of developing chronic kidney disease.

scholarly journals Effect of prenatal programming and postnatal rearing on glomerular filtration rate in adult rats

2015 ◽  
Vol 308 (5) ◽  
pp. F411-F419 ◽  
Author(s):  
German Lozano ◽  
Ayah Elmaghrabi ◽  
Jordan Salley ◽  
Khurrum Siddique ◽  
Jyothsna Gattineni ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Control Group ◽  
Adult Rats ◽  
Pregnant Rats ◽  
Mature Adult ◽  
Low Protein

The present study examined whether a prenatal low-protein diet programs a decrease in glomerular filtration rate (GFR) and an increase in systolic blood pressure (BP). In addition, we examined whether altering the postnatal nutritional environment of nursing neonatal rats affected GFR and BP when rats were studied as adults. Pregnant rats were fed a normal (20%) protein diet or a low-protein diet (6%) during the last half of pregnancy until birth, when rats were fed a 20% protein diet. Mature adult rats from the prenatal low-protein group had systolic hypertension and a GFR of 0.38 ± 0.03 versus 0.57 ± 0.05 ml·min−1·100 g body wt−1 in the 20% group ( P < 0.01). In cross-fostering experiments, mothers continued on the same prenatal diet until weaning. Prenatal 6% protein rats cross-fostered to a 20% mother on day 1 of life had a GFR of 0.53 ± 0.05 ml·min−1·100 g body wt−1, which was not different than the 20% group cross-fostered to a different 20% mother (0.45 ± 0.04 ml·min−1·100 g body wt−1). BP in the 6% to 20% group was comparable with the 20% to 20% group. Offspring of rats fed either 20% or 6% protein diets during pregnancy and cross-fostered to a 6% mother had elevated BP but a comparable GFR normalized to body weight as the 20% to 20% control group. Thus, a prenatal low-protein diet causes hypertension and a reduction in GFR in mature adult offspring, which can be modified by postnatal rearing.

scholarly journals The impact of hormonal contraceptives on blood pressure, urinary albumin excretion and glomerular filtration rate

2007 ◽  
Vol 63 (2) ◽  
pp. 224-231 ◽  
Author(s):  
Jarir Atthobari ◽  
Ron T. Gansevoort ◽  
Sipke T. Visser ◽  
Paul E. de Jong ◽  
Lolkje T. W. de Jong-van den Berg ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Urinary Albumin Excretion ◽  
Urinary Albumin ◽  
Hormonal Contraceptives ◽  
Albumin Excretion ◽  
The Impact

scholarly journals .Assessment of Renal Functions among Saudi Arabian Pregnant Women in Jazan Region

2015 ◽  
Vol 1 (1) ◽  
Author(s):  
Akram Hamed Awad All Elsukar - Ahmed Mohammed Ahmed
Keyword(s):  
Glomerular Filtration Rate ◽  
Pregnant Women ◽  
Glomerular Filtration ◽  
Plasma Flow ◽  
Filtration Rate ◽  
Renal Plasma Flow ◽  
Saudi Arabian ◽  
Serum Levels ◽  
Control Group ◽  
Renal Functions

Marked renal hemodynamic changes are apparent by the end of the first trimester. Both the Glomerular filtration rate and effective renal plasma flow increase by 50% of pregnant women. Effective renal plasma flow probably increases to a greater extent, and thus, the filtration fraction is decreased during early and mid-pregnancy. Objectives: To assess the serum levels of renal functions among Saudi Arabian Pregnant women in Jazan region. Materials and Methods: a prospective, case- control hospital based study conducted in Jazan region from March 2014– June 2015.30 pregnant women selected in Jazan General Hospital and assessed for renal function tests. 30 healthy subjects selected as control group who were age, and socioeconomic matched to the pregnancy group. SPSS was used for data analysis using student’s ‟t” test and Pearson's correlation for assessment of correlation between different variables. Results: There was a significant difference in the mean of the serum levels of urea and creatinine in test group (p<0.05) when compared to control group with a significant moderate positive correlation between serum levels of creatinine with the period of gestation. Conclusion: Serum levels of urea and creatinine significantly reduced in Saudi Arabian pregnant women. The progressive decrease in the levels of urea and creatinine through the 3 trimesters of pregnancy suggests an increase in Glomerular filtration rate, probably due to increased cardiac output, renal blood flow and changes in fluid distribution.

scholarly journals ROLE OF HYPOXIA–INDUCED APOPTOSIS IN CHRONIC GLOMERULONEPHRITIS PROGRESSION IN CHILDREN

2014 ◽  
pp. 41-45
Author(s):  
V.G. Maidannyk ◽  
E.A. Burlaka ◽  
I.V. Bagdasarova ◽  
S.P. Fomina ◽  
V.M. Nepomnyaschiy
Keyword(s):  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Kidney Function ◽  
Filtration Rate ◽  
Control Group ◽  
Chronic Glomerulonephritis ◽  
Disease Course ◽  
Function Impairment

Aim of the study: to study the indicators of cellular hypoxia and apoptosis in pediatric patients with nephritic type of chronic glomerulonephritis. Material and methods: 52patients with active stage of nephrotic type ofChronic glomerulonephritis were inspected. All patients were divided into groups of Chronic Kidney Disease (CKD) by the level of glomerular filtration rate (GFR). Detection of the hypoxia–induced factor (HIF) and antiapoptotic factor Bcl–xL in serum performed using Western Blotting assay and immunohistochemically on material of kidney biopsies. Imaging was done using confocal laser microscopy. Results: it has been found that the disease course is accompanied by increased levels of hypoxia–induced factor HIF–1a and decreased expression of antiapoptotic factor Bcl–xL (in plasma and on biopsies). Detected changes significantly depended on the degree of proteinuria and declining of glomerular filtration rate. Dependence between the levels of hypoxia–induced damages and level of kidney function impairment was documented. In children with Chronic Kidney Disease (SKDIst.) HIF–1a was at level 128.6±2.3% (P<0.01, compared to Control group), in children with CKD II–III st. – 141.3±1.9% (P<0.01, compared to Control group and CKD I st.). Level of antiapoptotic defense in children with nephrotic type of Chronic glomerulonephritis was related to the level of kidney function impairment as well. In group of patient with CKDIst. Bcl–xL expression was down–regulated to 75.1±2.2%, in group with CKDII–IIIst. — to 60.1+1.8% (P<0.01 and P<0.001, compared to Control group, respectively). The level of evaluated changes has a dependence on levels ofproteinuria and kidney function impairment. Conclusion. Studied parameters might be used as predictors of unfavorable disease course.

scholarly journals Indicators of hemodynamic and structural heart parameters in patients with comorbid pathology

2021 ◽  
Vol 90 (1) ◽  
pp. 44-51
Author(s):  
I.I. Topchii ◽  
P.S. Semenovykh ◽  
O.M. Kirienko ◽  
D.O. Kirienko ◽  
O.I. Tsygankov ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Diabetic Nephropathy ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Left Ventricular ◽  
Control Group

Currently, diabetes mellitus is a complex global problem, which is increasing every year. So in 2019, diabetes in the world was detected in 463 million adults (from 20 to 79 years old). And the main cause of death in patients with diabetes mellitus is cardiovascular complications. The features of functional and structural changes in the heart were studied in patients with type 2 diabetes mellitus and nephropathy. A total of 75 patients with type 2 diabetes mellitus were examined, of which 50 patients had diabetic nephropathy of varying severity. The control group consisted of 20 healthy individuals. The control group consisted of 20 practically healthy patients. After a clinical examination, depending on the state of renal function, all patients were divided into the following groups: group I consisted of 25 patients with type 2 diabetes mellitus without signs of nephropathy; group II consisted of 26 patients with type 2 diabetes mellitus with normal glomerular filtration rate and albuminuria; group III consisted of 24 patients with type 2 diabetes mellitus with decreased glomerular filtration rate and albuminuria. To study changes in hemodynamics and structural parameters of the heart, patients underwent transthoracic echocardiography on an ULTIMA PA ultrasound machine (Radmir, Ukraine) using a sectoral phased transducer with a frequency range of 2–3 MHz according to the standard technique according to the recommendations of the American Echocardiographic Society. Indicators the patients underwent anthropometric measurements. Patients with diabetic nephropathy and albuminuria and decreased glomerular filtration rate showed an increase in the linear dimensions of the heart in comparison with controls and patients without signs of nephropathy. With diabetic nephropathy patients have a significant increase in left ventricular myocardial mass and a significant increase in the detection rate of left ventricular hypertrophy up to 91.3 % in patients with albuminuria and preserved renal function and up to 100.0 % with a decrease in glomerular filtration rate. Keywords: diabetes mellitus, hypertonic disease, diabetic nephropathy, heart remodeling, chronic kidney disease.

Sign in / Sign up

Export Citation Format

Share Document