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Diabetic Nephropathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Chronic renal failure may be caused by anything that results in the kidneys functioning abnormally. The most common causes are diabetic nephropathy, hypertensive nephrosclerosis, and glomerulopathies, which can be primary or secondary. Primary glomerulopathies include focal segmental glomerulosclerosis, idiopathic crescentic glomerulonephritis, IgA nephropathy, membranoproliferative glomerulonephritis, and membranous nephropathy. Systemic diseases that may cause secondary glomerulopathies include amyloidosis, diabetes mellitus, Goodpasture syndrome, granulomatosis with polyangiitis, hemolytic-uremic syndrome, mixed cryoglobulinemia, postinfectious glomerulonephritis, and systemic lupus erythematosus. Metabolic syndrome with hypertension and type 2 diabetes mellitus is an increasingly common cause of kidney damage.
End Stage Disease
Published in Jeremy R. Jass, Understanding Pathology, 2020
In tubulointerstitial disease, the focus of inflammation is upon the interstitial connective tissue and the renal tubules. There are multiple causes, including repeated bacterial infection, obstruction of renal outflow and analgesic abuse (e.g. phenacetin) with associated papillary necrosis. Grossly the kidneys are shrunken with coarse scars, and often appear asymmetrical. An infective cause may be suspected from the patient’s history, through examination of the gross specimen for evidence of active inflammation in the collecting system and by the presence of lymphoid aggregates on histology. However, the histological appearance of ‘thyroidisation’ (dilated tubules filled with pink homogenous material resembling colloid) may also be formed in ischaemic kidneys. Additionally, ischaemic and hypertensive changes may be superimposed leading to secondary nephrosclerosis.
Vascular
Published in Michael Gaunt, Tjun Tang, Stewart Walsh, General Surgery Outpatient Decisions, 2018
Angioplasty is the treatment of choice for FMD. Recurrent and renal artery branch lesions also respond well. Angioplasty is less successful for atherosclerosis, and the main indication is to try and preserve existing renal function. For atherosclerotic RAS causing hypertension, the most suitable cases for angioplasty consist of a unilateral stenosis with a normal contralateral kidney. If hypertension has caused nephrosclerosis in the nonstenosed kidney there will be improvement in the hypertension.
Kidney physiology and pathophysiology during heat stress and the modification by exercise, dehydration, heat acclimation and aging
Published in Temperature, 2021
Christopher L. Chapman, Blair D. Johnson, Mark D. Parker, David Hostler, Riana R. Pryor, Zachary Schlader
The decline in kidney function associated with healthy aging is caused by many factors, including changes in anatomical structure and renal blood flow regulation. Davies et al. [433] were one of the first to identify that older adults (>60 years) have ~20% lower basal GFR (inulin clearance) and ~30% lower basal renal plasma flow compared to younger adults (<40 years). Larger disparities were observed between age groups for each decade beyond 60 years. This was subsequently followed up by investigations identifying that renal mass decreases with age such that after the age of 50 years kidney parenchymal volume declines by ~10% each decade, with larger decreases in men compared to women [434-436]. In addition to these morphological changes, the reduced kidney function with aging is also contributed to by a progressive loss of functional nephron mass [437]. For instance, Denic et al. [438] reported a 48% decrease in functional glomeruli (nonsclerotic) and a 15% increase in the number of nonfunctional glomeruli (globally sclerotic) with decreases in cortical volume of 16% in healthy adults >70 years compared to those aged 18-29 years. Biopsies from healthy living kidney donors older than 60 years revealed that 36% had >10% glomerulosclerosis with 63% of those individuals having tubular atrophy [439]. Thus, nephrosclerosis, which describes an aggregate of global glomerulosclerosis, arteriosclerosis, interstitial fibrosis and tubular atrophy, increases even with healthy aging [440].
Urinary D-serine level as a predictive biomarker for deterioration of renal function in patients with atherosclerotic risk factors
Published in Biomarkers, 2019
Hidehiro Iwakawa, Shin Makabe, Tomokazu Ito, Tohru Yoshimura, Hiroyuki Watanabe
The present study had some limitations. First, the size of the study population was relatively small, especially for the purpose of a multivariate Cox regression analysis. Thus, our results should be confirmed in a large population. Based on the rule of a minimum of 10 events per variable, an adequate sample size would be over 200 patients. Second, the total follow-up period was relatively short. This may explain our finding of a lack of an association between hypertension and diabetes mellitus, the leading cause of CKD, and renal events. Third, the proportions of men in this cohort was considerably larger than that of women, because we enrolled patients consecutively. Fourth, most of the patients in this study had a history of hypertension and/or diabetes. Thus, patients with nephrosclerosis and/or diabetic nephropathy were in the majority. However, we were unable to assess the precise degree of renal impairment at baseline, as kidney biopsies were not performed. Finally, this study did not clarify the underlying mechanism of urinary D-serine for deteriorating renal function. Further studies are needed to identify the precise mechanism of D-serine in humans.
High neutrophil/lymphocyte ratio is associated with poor renal outcomes in Japanese patients with chronic kidney disease
Published in Renal Failure, 2019
Ryota Yoshitomi, Masaru Nakayama, Teppei Sakoh, Akiko Fukui, Eisuke Katafuchi, Makiko Seki, Susumu Tsuda, Toshiaki Nakano, Kazuhiko Tsuruya, Takanari Kitazono
The median age of the 350 patients (239 males and 111 females) in this study was 68 years (range, 20–94 years). The primary causes of renal disease were chronic glomerulonephritis (37.1%, 130 patients), hypertensive nephrosclerosis (29.7%, 104 patients), diabetic nephropathy (19.7%, 69 patients), other defined causes (11.7%, 41 patients), and unknown (1.7%, 6 patients). The clinical characteristics of the subjects are summarized according to the values below and above the median NLR value in Table 1. The NLR values ranged from 0.51 to 1.86 in the low NLR group, and from 1.87 to 5.92 in the high NLR group. For all subjects, the median eGFR value was 33.6 mL/min/1.73 m2 (range, 15–120 mL/min/1.73 m2). Twenty-one patients were CKD stage 1, 56 patients were CKD stage 2, 127 were CKD stage 3, and 146 were CKD stage 4. The high NLR group was of older age and had a higher prevalence of male subjects, smoking and IHD, compared with the low NLR group. In addition, the high NLR group had significantly higher CRP and lower hemoglobin and eGFR levels compared with the low NLR group. Table 2 shows the relationship between NLR levels and clinical parameters analyzed by linear regression analysis. In the multivariable analysis, NLR was associated with the presence of IHD, eGFR, and CRP.