Faculty Opinions recommendation of Peripheral tissue release of interleukin-6 in patients with chronic kidney diseases: effects of end-stage renal disease and microinflammatory state.

Abstract Chronic inflammation plays an important role in the progression and outcome of chronic kidney disease (CKD). The inflammatory biomarkers interleukin-6 (IL6) and pentraxin 3 (PTX3) are enhanced in CKD patients and associated with progression of the disease and higher risk for cardiovascular events, the major cause of death in these patients. Our aim was to study how the polymorphisms of their encoding genes affect the inflammatory response and outcome of end-stage renal disease (ESRD) patients on dialysis. We analyzed two single nucleotide polymorphisms (SNP), the IL6 (rs1800795) polymorphism in the promoter region (-174G/C), and the PTX3 polymorphism in the intron 1 (+ 281A/G), in ESRD patients on dialysis and in heathy individuals. The allelic frequencies, genotype distribution and their association with the circulating levels of the inflammatory markers high sensitivity C-reactive protein (hsCRP), interleukin (IL6), growth differentiation factor 15 (GDF15) and PTX3, were determined in ESRD patients; events of death were recorded along one year to evaluate all-cause mortality and the association between inflammation and the studied polymorphisms. The allelic frequencies and genotyping distribution for IL6 and PTX3 in controls and ESRD patients were similar and in agreement with European reports. For the IL6 polymorphism, we found an association of the GG and CC genotype with higher IL6 levels; the CC genotype showed also high PTX3, hsCRP and GDF15 levels. For the PTX3 polymorphism, the AA genotype was linked to the highest values of hsCRP and IL6. The mortality rate after 1-year follow-up was 10.4%. The CC genotype (IL6 polymorphism), in deceased patients, was associated to increased levels of hsCRP, IL6 and PTX3, with low levels of GDF15 and with a highest mortality risk. The AA genotype for PTX3 polymorphism, in spite of the enhancement in inflammation, showed no significant impact on mortality. Our results show that the CC genotype of the IL6 polymorphism was associated with an enhanced inflammatory state and a poorer survival rate. Both IL6 and PTX3 polymorphisms seem to modulate the inflammatory response and, therefore, disease progression and outcome. Our data also highlights the importance of research on genetic variants that, although less frequent, may have significant biological value.

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Diabetic nephropathy: what should cardiologist remember

Consilium Medicum ◽

10.26442/20751753.2021.1.200712 ◽

2021 ◽

Vol 23 (1) ◽

pp. 20-24

Author(s):

Natalia P. Trubitsyna ◽

◽

Natalia V. Zaitseva ◽

Anastasia S. Severinа ◽

◽

...

Keyword(s):

Diabetes Mellitus ◽

Diabetic Nephropathy ◽

Renal Replacement Therapy ◽

Renal Disease ◽

Replacement Therapy ◽

End Stage Renal Disease ◽

Kidney Diseases ◽

Renin Angiotensin Aldosterone System ◽

Stage Renal Disease ◽

End Stage

Prevalence of diabetes mellitus (DM) progressively increases around the world. Diabetic nephropathy (DN) is significant reason of end-stage renal disease and it is associated with high risk of cardiovascular disease and mortality. Necessity of expensive renal replacement therapy for patients with prominent vascular diabetic complications and end-stage renal disease has significant socio-economic impact. DM, as a one of leading causes of kidney diseases, competes for stricted resources of public health. Renal replacement therapy in patients with DM does not solve the whole problem, because survival of such patients is low, comparing with another kidney diseases, first of all because of cardiovascular diseases. Good control of glycaemia, blood pressure and cholesterol level and prescription of renin-angiotensin-aldosterone system inhibitors and statins decrease cardiovascular risk and slow down DN progression, as it was shown in many clinical trials. So patients with DM and DN should receive complex therapy for risk reduction of kidney disease and cardiovascular disorders progression. Keywords: diabetes mellitus type 2, diabetic nephropathy, nephroprotection, cardioprotection, SGLT-2 inhibitors, GLP-1 agonists, renin-angiotensin-aldosterone system For citation: Trubitsyna NP, Zaitseva NV, Severinа AS. Diabetic nephropathy: what should cardiologist remember. Consilium Medicum. 2021; 23 (1): 20–24. DOI: 10.26442/20751753.2021.1.200712

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The Biology of the Mesothelium during Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686089501507s03 ◽

1995 ◽

Vol 15 (7_suppl) ◽

pp. 13-23 ◽

Cited By ~ 18

Author(s):

J. Thomas Hjelle ◽

Marcia A. Miller-Hjelle ◽

James W. Dobbie

Keyword(s):

Peritoneal Dialysis ◽

Renal Disease ◽

End Stage Renal Disease ◽

Kidney Diseases ◽

Host Defenses ◽

Therapeutic Modalities ◽

Stage Renal Disease ◽

End Stage ◽

Dialysis Solutions

Substantial derangements of mesothelial biology are observed during experimental simulations of dialysis conditions, inferred from the content of human dialysis effluent and visualized by microscopy of human mesothelial biopsies. Canosmotically active solutions be made biocompatible with the osmoregulatory system of the mesothelium? Can the contributions of the mesothelium to host defenses against inflammation and/or infection be supported during CAPD? Do underlying metabolic derangements present in various kidney diseases and end-stage renal disease, regardless of cause, require customized CAPD protocols and solutions? Use of dialysis solutions less directly toxic to the mesothelium is a necessary step toward some day manipulating peritoneal biology by pharmacological and therapeutic modalities.

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Diagnosing Nonneoplastic Lesions in Nephrectomy Specimens

Archives of Pathology & Laboratory Medicine ◽

10.5858/133.2.189 ◽

2009 ◽

Vol 133 (2) ◽

pp. 189-200 ◽

Cited By ~ 2

Author(s):

Luan D. Truong ◽

Steven S. Shen ◽

Moon-Hyang Park ◽

Bhuvaneswari Krishnan

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Kidney Diseases ◽

Massive Bleeding ◽

Urinary Obstruction ◽

Renal Neoplasms ◽

Clinicopathologic Correlation ◽

Cystic Changes ◽

Stage Renal Disease ◽

End Stage

Abstract Context.—Nonneoplastic changes are often identified in nephrectomy specimens removed for renal neoplasms. Although they may be of prognostic or therapeutic importance, they are often overlooked. Nephrectomy is also performed for nonneoplastic lesions, the most frequent of which are urinary obstruction and end-stage renal disease, but the tissue diagnosis of these conditions and the implicated clinicopathologic correlation may not be well appreciated. Objective.—To outline these nonneoplastic lesions with special attention to important diagnostic caveats and clinicopathologic correlations. Data Sources.—The presented information was derived from literature, personal experience, and review of case materials at the authors' institutions. Results.—Nonneoplastic lesions are seen in most (90%) nephrectomy specimens removed for renal neoplasms. Although these lesions span the spectrum of “medical” kidney diseases, the most frequent of them are hypertensive nephrosclerosis and diabetic nephropathy. Recognition of these diseases is important because they are often first diagnosed and later confirmed clinically. Furthermore, the severity of these lesions may predicate both short- and long-term renal function and thus help guide treatment. Among conditions that necessitate nephrectomy, advanced urinary obstruction, end-stage renal disease, and end-stage renal disease with acquired cystic changes are probably the most frequent. These conditions have characteristic morphologic features, but they may be associated with superimposing lesions previously not well described. These superimposing lesions may create diagnostic confusion; yet, some of them are the reason for nephrectomy. Thus, acute bacterial infection, urine polyp, granulomatous pyelitis, papillary necrosis, massive bleeding, and renal dysplasia can develop against the background of obstructive nephropathy. Renal neoplasms may develop from the background of end-stage renal disease without cystic changes. A renal neoplasm or massive bleeding with or without neoplasm is usually the reason for nephrectomy in kidney with acquired cystic kidney diseases. Thus, while nonneoplastic changes are frequent in nephrectomy specimens, they are often unrecognized. Awareness of these conditions and a familiarity with their diagnostic features as well as the implicated clinicopathologic correlation should help obviate this diagnostic problem.

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A Review of the Potential Benefits of Pentoxifylline in Diabetic and Non-Diabetic Proteinuria

Journal of Pharmacy & Pharmaceutical Sciences ◽

10.18433/j3bp4g ◽

2011 ◽

Vol 14 (1) ◽

pp. 128 ◽

Cited By ~ 22

Author(s):

Shirinsadat Badri ◽

Simin Dashti-Khavidaki ◽

Mahboob Lessan-Pezeshki ◽

Mohammad Abdollahi

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Large Scale ◽

Kidney Diseases ◽

Scientific Basis ◽

Sustained Reduction ◽

Number Of Patients ◽

Stage Renal Disease ◽

End Stage

Chronic kidney disease (CKD) as a considerable health problem may have proteinuria as the main complication and strong risk factor to reach end-stage renal disease (ESRD). Decreasing proteinuria is the mainstay of therapy in order to delay the progression of CKD. Current therapeutic regimens provide only partial renoprotection, and a substantial number of patients who have proteinuria progress to ESRD. Pentoxifylline (PTF) is known for its potent inhibitory effects against cell proliferation and inflammation which play important roles in CKD progression. Data derived from both human studies and animal models demonstrated that PTF has broad-spectrum renoprotective effects and therefore, provide a scientific basis for the use of PTF as an anti-proteinuric agent. Conclusion of this review is that short-term use of PTF may produce a significant reduction of proteinuria in subjects with diabetic and also non-diabetic kidney diseases but the reports of long-term use of PTF also show that urinary protein excretion exhibits a progressive and sustained reduction in patients treated with PTF. Whether the long-term use of PTF could be a pharmacological alternative for delaying or preventing the development of end stage renal disease, is among the questions that remained to be appropriately answered in large-scale clinical trials.

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