Nicotinamide Attenuates the Progression of Renal Failure in a Mouse Model of Adenine-Induced Chronic Kidney Disease

Nicotinamide adenine dinucleotide (NAD+) supplies energy for deoxidation and anti-inflammatory reactions fostering the production of adenosine triphosphate (ATP). The kidney is an essential regulator of body fluids through the excretion of numerous metabolites. Chronic kidney disease (CKD) leads to the accumulation of uremic toxins, which induces chronic inflammation. In this study, the role of NAD+ in kidney disease was investigated through the supplementation of nicotinamide (Nam), a precursor of NAD+, to an adenine-induced CKD mouse model. Nam supplementation reduced kidney inflammation and fibrosis and, therefore, prevented the progression of kidney disease. Notably, Nam supplementation also attenuated the accumulation of glycolysis and Krebs cycle metabolites that occurs in renal failure. These effects were due to increased NAD+ supply, which accelerated NAD+-consuming metabolic pathways. Our study suggests that Nam administration may be a novel therapeutic approach for CKD prevention.

Daratumumab in light chain deposition disease: rapid and profound hematologic response preserves kidney function

Key Points Daratumumab is effective in treated light chain deposition disease. Daratumumab can prevent progression of renal failure in these patients.

Comorbidity in gout and hyperuricemia: prevalence, causes, prospects of urate lowering therapy

Nowadays, there is increased interest in the connection of gout and asymptomatic hyperuricemia with comorbid conditions such as diabetes mellitus, cardiovascular diseases, hypertension, chronic kidney disease and other. Studies conducted over the past few decades suggest that not only gout, but also asymptomatic hyperuricemia can significantly worsen the prognosis in patients with cardiovascular diseases, as the deposition of urate crystals can be both an immediate cause and a factor in the progression of renal failure. In that way, the timely appointment of urate - lowering therapy and achieving the target serum uric acid level can not only affect joint damage, but also can significantly slow the progression of life - threatening comorbid conditions.

Study of comparative evaluation of Atorvastatin and Salicinol (salacia roxburghii) on GFR and carotid intima media thickness in diabetic and non-diabetic CKD patients with hypertension

Background: Most of the newer concepts in Nephrology developed in the 19th and 20th centuries. Progression of renal failure is an area of Nephrology where our understanding has improved appreciably in the last century, but still, our knowledge is like a drop in the ocean. We have ample evidence that the progression of renal failure can be slowed down, but we still need more definite information on whether established renal failure can be reversed. This pilot clinical study was planned to explore the therapeutic potential of salicinol in retardation of chronic kidney disease progression and anti-atherosclerotic property by looking for if a reduction in CIMT is possible. Objectives: To study of comparative evaluation of atorvastatin and salicinol (salacia roxburghii) on GFR and CIMT in diabetic and non-diabetic CKD patients with hypertension. Methods: The present study was conducted in the Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi. Eighty patients of mild to moderate stable chronic renal failure with hypertension attending Nephrology OPD or admitted in the Nephrology ward from May 2014 to June 2015 were included in the study. Patient with acute MI, congestive heart failure, unstable angina, myopathy. Subsequently, patients were allocated to one of the two groups, the first group consisted of Diabetic patient treated with atorvastatin salicinol, and second group was of non-diabetic treated patients. Results: Among total patients included in study, 35 were non-diabetic, and 45 were diabetic. Mean serum creatinine at baseline study in the diabetic and non-diabetic group were 4.3 ± 2.0, and 5.0 ± 1.6, and changes were statistically significant intragroup. Mean CIMT in diabetic and non-diabetic at baseline were 0.92 ± 0.07 and 0.90±0.07, and when comparing both changes were statistically significant at three months and 6 months suggesting CIMT regression more in diabetic groups compared to non-diabetics. Mean GFR in a diabetic and non-diabetic group at baseline was 23.4 ± 15.6 and 17.8±13.7. On intergroup comparison, changes were statistically significant at 3 months and at 6-month. Conclusion: The male to female ratio was 2:1. Age of the patient ranged from 20years onwards. No significant effect of the drug was seen on 24hrs urinary protein, blood pressure, hemoglobin and GFR. On comparison of non-diabetic and diabetic significant decreases (0.05) in GFR were observed at the end of the study. On comparison of non-diabetic and diabetic highly significant decrease (0.001) in CIMT were observed at three months and at the end of the study.

EFFECT OF CHRONIC RENAL DYSFUNCTION ON THE PERMEABILITY OF THE COLON TO WATER AND ELECTROLYTES: EXPERIMENTAL STUDY IN RATS

ABSTRACT Background: Renal insufficiency is a disease that affects several organs by provoking hypervolemia and uremia. The disease reaches more than 500 million people worldwide and few studies bring their influence on the gastrointestinal tract. Aim: To evaluate the influence of 5/6 nephrectomy-induced hypervolemia on colonic permeability to water and electrolytes. Method: Sixty male Wistar rats weighing between 280-300 g were divided into three groups: 3, 7 and 14 days after nephrectomy, each one having a false-operated/control and partially nephrectomized. For colonic permeability they were submitted to colonic perfusion with a solution of Tyroad containing phenolphthalein. Differences among the concentrations of Na+, K+ and Cl- were used to calculate the rate of colonic permeability for the electrolytes. Phenolphthalein concentrations were used to evaluate the rate of secretion and water absorption. Results: The colonic secretion of water and electrolytes occurred expressively in the group seven days after nephrectomy. Hemodynamic and biochemical assessments determined the progression of renal failure in all three groups and polyethylene glycol was shown to be effective in reversing the secretory capacity of the colon. Conclusion: Hypervolemia established after 7 days post-nephrectomy 5/6 caused marked colonic secretion for water and electrolytes. The organism presents progressive colonic secretion as the blood volume increases; on the other hand, polyethylene glycol was able to revert this secretory framework of the colon to water and electrolytes by reversing the hypervolemia.

Influence of infiltrate density in the interstitium on the prognosis of primary glomerulonephritis

Background/Aim. Development of inflammatory changes, fibrosis and loss of morphological structures of the interstitium have an important role in pathogenesis of primary glomerulonephritis, affecting the development, course and prognosis of the disease. The aim of this study was to determine the influence of changes in the interstitium on the prognosis of primary glomerulonephritis. Methods. The research included 216 patients suffering from different types of primary glumeronephritis treated at the Clinic for Nephrology and Clinical Immunology of the Clinical Center of Vojvodina, Serbia who were being monitored on average for 77.5 months. After determining on pathohistological diagnosis of the type of glomerulonephritis, renal changes in the interstitium were quantified. Numerical density in the tissue volume unit and structure of infiltrates of the interstitium were established by using the Weibel system (M42) incorporated into light microscope. Routine analyses were performed by using standard laboratory procedure. Results. During the research period the highest numerical density of infiltrates was verified in extracapillary glomerulonephritis (147,869 ? mm-3), slightly less in membranoproliferative glomerulonephritis (116,800 ? mm-3) and focal segmental glomerulosclerosis (96,147 ? mm-3), and the least being in glomerulonephritis with minimal changes (11,416 ? mm-3). In all types of glomerulonephritis, apart from glomerulonephritis with minimal changes, there was a significantly (p < 0.0005) higher numerical density and incidence of infiltrate cells in relation to the control group. By comparing the numerical density of infiltrates of all cells to the parameters of renal function, a significant (p < 0.01) correlation of these phenomena was established. In order to get a better insight into the speed of progression of renal failure by setting a numerical limit of the density of infiltrates < 100,000 / > 100,000 cells/mm3, regardless of the type of glomerulonephritis, a prognostic predictor was established on the basis of which the patients with lower infiltration of the interstitium had significantly (p < 0.005) lower progression of renal failure. Conclusion. Density of infiltrates in the interstitium in primary glomerulonephritis is an important early prognostic predictor of progression of renal failure.

Epidemiology and chronic kidney disease as a cardiovascular risk factor

Chronic kidney disease defined by an estimated glomerular filtration rate of less than 60 mL/min or the presence of albuminuria is present in about 10% of the European populations. The risk increases with age, arterial hypertension, and diabetes. Both aspects—reduced estimated glomerular filtration rate, and albuminuria—are major factors associated with the progression of renal failure, cardiovascular events, and all-cause mortality. Patients on dialysis have a 10- to 20-fold increase in the cardiovascular event rate. Furthermore, heart failure and sudden cardiac death are associated with the severity of renal failure.

Dyslipidemia in chronic kidney disease excluding diabetic and nephrotic aetiology

Background: Dyslipidemia is hypothesized as one of the risk factor of chronic kidney disease and plays an important role in the progression of renal failure. The present study was conducted to assess the association between ratio of TG/HDL-C and CKD and other abnormalities in the lipid profile in CKD patients.Methods: This case-control study was conducted in Government General Hospital from July 2013 to November 2013. 100 patients with CKD were included as study cases. 100 healthy patients from the same hospital, who came with different illness other than the study disease were included as controls. Fasting lipid profile was done – total cholesterol, triglycerides and high-density lipoproteins (HDL) were measured and low-density lipoproteins, & TG/HDL ratio were calculated. Comparison of lipid parameters among study and control groups was done. P value <0.05 was considered as statistically significant.Results: Majority of the study patients were under the age group of 40-50 years. Male dominance (86%) was seen in the study group. The association of HDL, LDL, TGL, TGL/HDL, TC parameters and stages of CKD was observed and found to be statistically significant (p value <0.0001 and <0.05). Comparison of lipid parameters among study and control groups were done and difference was found to be statistically significant (p value <0.0001).Conclusions: Dyslipidemia should be treated in early stages of CKD to prevent secondary complications.