Physical activity and kidney function in health and disease
Roy J. Shephard in Physical Activity and the Abdominal Viscera, 2017
This chapter examines the impact of physical activity upon the normal functioning of the kidneys, and explores such manifestations of temporary dysfunction as exercise-induced microproteinuria and microhaematuria. It considers the potential of developing acute renal failure during a prolonged bout of exhausting exercise and the possibility of chronic renal damage in athletes with an excessive intake of creatine supplements or non-steroidal anti-inflammatory drugs (NSAIDs). The chapter examines the place of exercise programmes in the rehabilitation of patients who are undergoing dialysis or who have received renal transplants, and it considers the possibility that regular physical activity may reduce the risk of renal cancer. A large intake of anti-inflammatory drugs can also have adverse effects on the kidney, particularly in individuals whose bodies normally rely on an increased prostaglandin secretion to counter a reduced renal blood flow. In humans, vigorous physical activity leads to a progressive drop in the glomerular filtration rate (GFR) as renal perfusion decreases.
Renal disease
Catherine Nelson-Piercy in Handbook of Obstetric Medicine, 2020
The ‘physiological hydronephrosis’ of pregnancy can be dismissed as normal up to a pelvicaliceal diameter of about 2 cm. Although urinary tract infection is a common and important problem in pregnancy, it should never be assumed to be the cause of abdominal pain and/or proteinuria before further investigation to confirm or refute the diagnosis is undertaken. Increased proteinuria is a physiological response to pregnancy and may not necessarily indicate superimposed pre-eclampsia or deteriorating renal disease. It also results from withdrawal of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers before or in early pregnancy. In general, women without hypertension or renal impairment prior to conception have successful pregnancies and pregnancy does not adversely influence the progression of the kidney disease. Women receiving renal transplants should be counselled that as renal function returns to normal (usually rapidly after successful transplantation), ovulation, menstruation and fertility also resume.
Renal disease in children
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
The management of antenatal hydronephrosis is also protocol based in order to detect children with congenital abnormalities of the kidney and urinary tract who may require intervention, and prior to them developing symptoms or signs of chronic kidney disease. However, 50% of cases with antenatal renal tract dilatation will be transient hydronephrosis and will have normal postnatal imaging. Cystic kidneys can be seen with renal dysplasia, autostomal recessive and dominant polycystic kidney disease, glomerulocystic diseases, and tuberous sclerosis with multicystic dysplastic kidneys referring to large kidneys without functioning parenchyma. Small kidneys are seen in renal dysplasia with or without vesicoureteric reflux and after vascular insults. The management of paediatric renal transplant recipients is by specialist teams involving paediatric nephrologists, urologists and transplant surgeons. However, paediatric renal transplant recipients suffer from usual childhood illnesses, such as appendicitis, but are also at higher risk of infections due to immunosuppression.
Switching from allopurinol to febuxostat: efficacy and safety in the treatment of hyperuricemia in renal transplant recipients
Published in Renal Failure, 2019
Yanchun Li, Min Liu, Xuelei Zhang, Yuewu Lu, Juan Meng
The aim of this study was to evaluate the efficacy and tolerability of febuxostat in renal transplant recipients who were previously treated with allopurinol (the daily oral dose is 100 mg). A 6-month cohort study was conducted with 46 renal transplant recipients who had hyperuricemia. In 22 patients, treatment was changed from allopurinol to febuxostat (febuxostat was given at an oral dose of 20 mg once a day), and the other 24 patients continued the allopurinol treatment (the daily oral dose is 100 mg). The serum levels of uric acid (UA), creatinine, other biochemical parameters, estimated glomerular filtration rate (eGFR), and adverse events were measured at baseline as well as at 1, 3, and 6 months after the switch to febuxostat. Serum UA levels significantly decreased from 470.82 ± 34.37 to 378.77 ± 51.97 μmol/L in the febuxostat group, and decreased from 469.46 ± 33.47 to 428.21 ± 23.37 μmol/L in the allopurinol group. The eGFR increased from 75.55 to 85.23 mL/min in the febuxostat group, and decreased from 78.79 to 70.31 mL/min in the allopurinol group. In renal transplant recipients, febuxostat reduced the serum UA levels resulting in minor short-term improvement of renal function with no changes in the other biochemical parameters.
Variability in the leptin receptor gene and other risk factors for post-transplant diabetes mellitus in renal transplant recipients
Published in Annals of Medicine, 2019
Sonia Mota-Zamorano, Enrique Luna, Guadalupe Garcia-Pino, Luz M. González, Guillermo Gervasini
Aim: Post-transplant diabetes mellitus (PTDM) is one of the main complications after kidney transplantation. It is known that leptin plays an important role in glucose metabolism and mutations in the leptin receptor gene (LEPR) are responsible for different complications in renal transplant recipients. We aimed to analyse the association of polymorphisms in LEPR with the development of PTDM in these patients. Methods: A total of 315 renal transplant recipients were genotyped for the Lys109Arg, Gln223Arg and Lys656Asn polymorphisms. The impact of these genetic variables together with other clinical and demographic parameters on PTDM risk was evaluated in a multivariate regression analysis. Results: The 223Arg variant showed a significant association with PTDM risk [OR = 3.26 (1.35–7.85), p = 0.009] after correcting for multiple testing. Carriers of this variant also showed higher BMI values (26.95 ± 4.23) than non-carriers (25.67 ± 4.43, p = 0.025). In addition, it was BMI at transplant and not the BMI increment in the first year after grafting that was associated with PTDM (p > 0.00001). Haplotype analyses did not reveal significant associations. Conclusions: Our result show, for the first time to our knowledge, that genetic variability in the LEPR may contribute significantly to the risk for PTDM in renal transplant recipients.KEY MESSAGESThe LEPR Gln223Arg polymorphism significantly contributes to the development of PTDM in renal transplant recipients.The effect of the 223Arg variant on PTDM is strongly modulated by the age of the recipient.The 223Arg variant in the leptin receptor is related to higher BMI in renal transplant recipients.
Effect of a booster dose of influenza vaccine in patients with hemodialysis, peritoneal dialysis and renal transplant recipients: A systematic literature review and meta-analysis
Published in Human Vaccines & Immunotherapeutics, 2016
Zhengfa Liao, Xiaojia Xu, Yaping Liang, Yongzhen Xiong, Ruoling Chen, Jindong Ni
Booster influenza vaccination has been recommended for patients with chronic renal disease in order to enhance the immune response to the influenza vaccine; however, the efficacy of a booster influenza vaccination is a matter of controversy. Therefore, we made a meta-analysis to determine the efficacy in patients with hemodialysis (HD), peritoneal dialysis (PD) and renal transplant recipient (RT). The sero-protection rate was used as a serologic parameter to describe the immune response to the vaccine. Statistical analysis was performed to calculate the pooled rate difference (RD) and 95% confidence interval (CI). The pooled RD for the H1N1, H3N2 and B influenza vaccines was 0.02 (95% CI: −0.02–0.06), 0.05 (95% CI: −0.01–0.11), 0.04 (95% CI: −0.02–0.10), respectively. We concluded that a booster dose of the influenza vaccine did not effectively enhance immunogenicity. Therefore, a booster dose of vaccine is not recommended for patients with hemodialysis, peritoneal dialysis and renal transplant recipients.
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