Occult Adrenal Insufficiency in Patients with Chronic Renal Disease

Background: Addison’s disease is a rare disorder of the adrenal cortex that leads to inadequate production of cortisol initially followed by aldosterone and androgens. Its manifestations are usually slow and non-specific with potential for life-threatening adrenal crisis following hypermetabolic demands (infection, trauma, surgery). Patients: Over the past 10 years, 19 CRD-patients were diagnosed with occult PAI in our center. Results: Unprovoked hypotension was the most common manifestations of occult PAI and was the unmasking event in 11 (58%). It was without significant cardiac and/or severe systemic sepsis and was refractory to isotonic saline infusions. Equal number of the remaining patients (n = 2) presented with persistent and inexplicable electrolytes abnormalities viz. 1) hyponatremia despite restricted oral fluid intake, lack of dehydration and massive fluid overload, as well as 2) hyperkalemia despite potassium-restricted diet, hyperkalemic drugs and adequate therapy with Furosemide and low-potassium dialysis-baths. On the other hand, similar proportions presented with unprovoked 3) progressive weight loss, decrease appetite and cachexia as well as 4) frequent hypoglycemic attacks. All patients were treated and were medically stable after 29 (2 - 60) months of follow up. Autoantibodies to 21-hydroxylase enzyme were positive in 16 (90%). At diagnosis, and subsequent follow up, only 7 patients (37%) had multi-endocrine dysfunction of whom 2 with type 1 and 5 with type 2. Conclusion: High index of suspicion should be exerted in diagnosis of PAI in patients with CRD, since its clinical picture is similar to CRD manifestations and complications. In those patients, confirmatory tests and specific management can save their lives. .

Significance of plasma von Willebrand factor level and von Willebrand factor-cleaving protease activity in patients with chronic renal diseases

Background von Willebrand factor （vWF） mediates the initial capture of platelets to vascular subendothelium and is essential for platelet aggregation under high fluid shear stress as in arterial stenosis. On release from endothelial cells, vWF is rapidly cleaved by ADAMTS13/vWF-cleaving protease （vWF-CP）. We investigated the clinical significance of changes in plasma vWF and vWF-CP activities in chronic renal disease.Methods Plasma vWF and vWF-CP activities were measured using enzyme-linked immunosorbent assay （ELISA） and residual collagen binding assay respectively in patients with lupus nephritis （n=31）, primary nephritic syndrome （n=25）, diabetic nephropathy （n=45）, chronic glomerulonephritis （n=38） and 40 normal controls. The relation of their levels with pathological and renal status was analyzed.Results In all diseased patients the levels of vWF were significantly higher and vWF-CP activity significantly lower than the controls （both P〈0.01）. vWF in the four subgroups did not correlate with the stage of disease but correlated negatively with vWF-CP activity, vWF-CP activity was not changed two weeks after renal transplantation. Renal biopsy demonstrated that the vWF level in stage IV was higher than in stages II and III while vWF-CP activity was lower in patients with lupus nephritis. After eight-week treatment, the vWF level significantly decreased and the vWF-CP activity significantly increased in systemic lupus erythema, disease activity index 〈9, but not with index 〉9. Even though the vWF-CP activity was significantly lower in membranous nephropathy than in minimal change disease, mesangial proliferative glomerulonephritis or IgA glomerulonephritis, the vWF level was not significantly different. Conclusions The alterations of plasma vWF and vWF-CP activities were associated with different renal pathologies. Injury to endothelial cells and autoantibodies against vWF-CP activity may result in higher vWF level and lower vWF-CP activity in chronic renal disease and thus a mechanism for worsening of chronic renal disease and thrombosis.

Renoprotective strategies

Kidney disease remains a condition with an increasing incidence,high morbidity and mortality associated with cardiovascular events.The incidence of end-stage renal disease is expected to increase.Despite of the technical improvement,dialysis never achieved a full clearance of the blood dialysis.Therefore,the demand for new renoprotective measures has never been greater.Here,we report new strategies for preventing renal damage.

Impact of renal transplantation on cardiac morphological and functional characteristics in children and adults

AIM To compare the effects of renal transplantation on cardiac functions in children and adults.METHODS One hundred and ten patients attending the nephrology outpatient clinic were enrolled in this study and were divided into six groups. The first two groups consisted each of 30 renal transplant patients who had a successful renal transplantation more than six months, but less than one year. Group Ⅰ were less than 18 years and group Ⅱ were more than 18 years. The third and fourth groups, each were 20 chronic renal failure patients on regular hemodialysis. Again, group Ⅲ were less than 18 years and group Ⅳ were more than 18 years. Group Ⅴ and Ⅵ(The control Groups) consisted each of 5 subjects below and above 18 years of age, respectively with normal kidney functions. All patients were subjected to history and examination. The kidney functions and the hemoglobin were analyzed. Afterobtaining informed consent, echocardiography was done to all patients.RESULTS There was a statistically significant improvement(P < 0.0001) in all cardiac parameters. A regression in left ventricular end diastolic volume(LVED) both in children(4.7 ± 0.8 to 4.2 ± 0.5) and in adults(5.9 ± 0.7 to 4.9 ± 0.6) were found. There was a regression in left ventricular end systolic volume(LVES) both in children(3.1 ± 0.6 to 2.4 ± 0.4) and in adults(4.1 ± 0.9 to 3.1 ± 0.5). Fractional shortening improves both in children(32.6 ± 5.3 to 41.7 ± 7.6) and in adults(29.0 ± 6.6 to 36.5 ± 4.1). The improvement in ejection fraction(EF) was higher in children(59.7 ± 7.0 to 71.9 ± 6.1) than in adults(52.0 ± 12.5 to 64.8 ± 5.9). However, this degree of improvement(in children: 12.2 ± 5.1) did not show statistical difference(P-value 0.8), when compared to adults(12.7 ± 9.8). CONCLUSION After renal transplantation cardiac functions and morphology(EF/LVED/LVES) do improve markedly and rapidly in both children and adults.

Study on the changes in pulmonary artery pressure in elderly Chronic kindney disease patients without end-stage renal disease

Objective To prospectively investigate the characteristics and correlative influential factors for the changes in pulmonary artery hypertension(PAH)in chronic kidney disease(CKD)patients without end-stage renal disease.Methods Complete clinical and laboratory data of133 outpatients without ESRD(CKD stage 2,3 and 4)

New evidence for a role of Bisphenol A in cell integrity.Implications in the human population

Bisphenol A(BPA)is a xenoestrogen known for its implications for the endocrine systems and several other organs,including the kidneys.Recent renal studies have shown that BPA can induce alterations of the cytoskeleton and cell adhesion mechanisms such as a podocytopathy with proteinuria and hypertension,alterations involved in the progression of renal diseases.These data and the fact that BPA is known to be present in the urine of almost the entire population strongly suggest the critical need to reevaluate BPA exposures considered safe.

Dyslipidemia promotes the progression of chronic kidney disease

Dyslipidemia, including hypercholesterolemia, hypertriglyceridemia, and low high-densitylipoprotein （HDL） cholesterinemia, is a key risk factor to atherosclerosis. The detrimental effect of elevated low-density lipoprotein （LDL） cholesterol and/or decreased HDL cholesterol on cardiovascular disease risk had been well established from previous studies.1 Recently, emerging evidences suggest that dyslipidemia may also be an important contributor to morbidity and mortality of chronic kidney disease （CKD）, which has received more and more attention as the prevalence of CKD increases.

Analysis of structural components of decellularized scaffolds in renal fibrosis

Chronic kidney disease has been recognized as a major public health problem worldwide and renal fibrosis is a common pathological process occurring in chronic renal failure.It is very promising to find the strategies to slow or even prevent the progression of fibrosis.This study focused on whether renal fibrosis decellularized scaffolds has the potential to be a model of cellular mechanisms of tissue fibrosis or donors for tissue engineering.In order to evaluate the feasibility of decellularized scaffolds derived from pathological kidneys,histology,proteomics and ELISA will be used to analysis the changes in the structure and main components of fibrotic tissue.The fibrosis model in this paper was induced by adenine-fed and the results showed that the structure of fibrotic scaffold was changed and some protein were up-regulated or down-regulated,but the cytokines associated with renal regeneration after injury were remained.In cell experiments,endothelial progenitor cells proliferated well,which proved that the fibrotic scaffolds have non-cytotoxic.All these conclusions indicate that the renal fibrosis decellularized scaffolds model has the ability to study fibrosis mechanism and the potential to be engineering donors as well as normal scaffolds.