Sinkihwan-gamibang ameliorates puromycin aminonucleoside-induced nephrotic syndrome / 中国天然药物

Nephrotic syndrome (NS) is a kidney disease characterized by hypertriglyceridemia, massive proteinuria, hypo-albuminemia and peripheral edema. Sinkihwan-gamibang (SKHGMB) was recorded in a traditional Chinese medical book named "Bangyakhappyeon ()" and its three prescriptions Sinkihwan, Geumgwe-sinkihwan, and Jesaeng-sinkihwan belong to Gamibang. This study confirmed the effect of SKHGMB on renal dysfunction in an NS model induced by puromycin aminonucleoside (PAN). The experimental NS model was induced in male Sprague Dawley (SD) rats through injection of PAN (50 mg·kg-1)via the femoral vein. SKHGMB not only reduced the size of the kidneys increased due to PAN-induced NS, but also decreased proteinuria and ascites. In addition, SKHGMB significantly ameliorated creatinine clearance, creatinine, and blood urea nitrogen. SKHGMB relieved glomeruli dilation and tubules fibrosis in the glomeruli of the NS model. SKHGMB inhibited the protein and mRNA levels of the NLRP3 inflammasome including NLRP3, ASC, and pro-caspase-1 in NS rats. SKHGMB reduced the protein and mRNA levels of fibrosis regulators in NS rats. The results indicated that SKHGMB exerts protective effects against renal dysfunction by inhibiting of renal inflammation and fibrosis in NS rats.

Ácido úrico como marcador pronóstico de Proteinuria en 24 horas en pacientes diabéticos / Uric acid as a prognostic marker of Proteinuria in diabetic and renal patients

Desde el desarrollo de la Diabetes Mellitus (DM) hasta la aparición de nefropatía transcurren varios años, siendo la albuminuria la primera evidencia de la misma. El Ácido Úrico (AU) parece ser importante en la génesis de nefropatía diabética. Objetivo: Determinar la relación entre niveles séricos de AU y valores de proteinuria en 24 horas en pacientes diabéticos que acudieron a las consultas de Diabetes y Nefrología. Métodos: Estudio de campo, transversal y correlacional. Se determinaron niveles séricos de glicemia, creatinina y AU, además de proteinuria en 24 horas en 94 pacientes, que fueron divididos en 2 grupos: ≤5 años y >5 años de diagnóstico de la DM. Resultados: La edad promedio fue 62,4+ 12,9 años. Predominó el género femenino (69,1%). La DM tipo 2 representó 97,1%. Las complicaciones crónicas más frecuentes fueron las Cardiovasculares (45,7%) y la Nefropatía (30,9%). El valor promedio de Glicemia en ayunas fue 138,1+ 58,5 mg/dl, Creatinina 1,15 + 0,84 mg/dl, AU 4,9+1,8 mg/dl. La mediana de Proteinuria en 24 horas fue 112,1mg/24horas / Varianza (σ) 697872 (mg/24 horas)2. 37, 2% presentó Enfermedad Renal Crónica estadio 2. Se encontró HTA en 72,7% de pacientes con AU elevado. El AU mostró correlación positiva con proteinuria en 24 horas mayor a 150 mg/dl. 4,75 mg/dl funcionó como punto de corte del AU, con 69% de sensibilidad y 69,23% de especificidad. Valores superiores a éste tradujeron 5 veces más riesgo de proteinuria >150 mg/dl. El AU resultó ser un fuerte indicador pronóstico para la aparición de proteinuria(AU)

It often takes several years since the development of Diabetes Mellitus (DM) until the onset of ephropathy, and usually albuminuria is the first clinical evidence of kidney damage. Uric Acid (UA) seems to play an important role in diabetic nephropathy. Objective: To determine the relationship between serum UA and 24-hours Proteinuria in diabetic patients treated on the Diabetes and Nephrology outpatient consultations. Methods: A descriptive cross-sectional correlational study was conducted on 94 patients. Fasting plasma glucose, serum creatinine and UA were determined, as well as 24-hour Proteinuria. Patients were classified into 2 groups: ≤5 years and >5 years since the diagnosis of DM. Results: The mean age was 62, 4+ 12, 9 years. The majority of patients were females (69, 1%). DM2 accounted for 97,1% of all Diabetes types. Cardiovascular diseases (45,7%) and Nephropathy (30,9%) were the most common chronic complications. Fasting plasma glucose mean was 138,1+ 58,5 mg/dl, Creatinine 1,15 + 0,84 mg/dl, UA 4,9+1,8 mg/dl. 24-hours Proteinuria median was 112,1mg/24horas / Variance (σ) 697872 (mg/24- hours) 2. 37,2% showed stage 2 Chronic Kidney Disease. Arterial hypertension was found on 72,7% of the sample with increased UA levels. UA displayed a positive association with 24-hour roteinuria > 150 mg/24 h. 4,75 mg/dl was found as the cut-off point, with sensitivity of 69% and specificity of 69,23%. Subjects with Serum UA above 4,75 mg/dl had a 5 times higher risk of proteinuria>150 mg/dl. Conclusion: UA was a strong prognosis marker for the onset of proteinuria in diabetic patients(AU)

Predicting 24-hour urinary protein excretion in Afro-Caribbean Barbadians by comparing urine protein excretion over different durations versus spot collection / Predicción de la excreción de proteína en orina de 24 horas en Barbadenses Afrocaribeños mediante la comparación de la excreción de proteínas en la orina en diferentes períodos de tiempo frente a la recogida al azar

AIM: The gold standard for the determination of proteinuria, an independent risk factor for cardiovascular and renal disease, is the measurement of protein in a 24-hour urine collection. However, this method has been shown to be unreliable mainly due to poor compliance of sampling by patients. This study investigates other appropriate means of predicting 24-hour urinary protein excretion in a sample of Afro-Caribbeans in Barbados by assessing the correlation of actual and estimated urinary protein excretion between a 24-hour urine collection sample, 12hour (AM and PM) and spot (AM and PM) urine collections. SUBJECTS AND METHOD: A convenient sample of 30 healthy participants of Afro-Caribbean origin between the ages of 21 and 55 years was recruited for the study. The 24-hour urine samples and anthropometric data were collected as documented in the study's standard clinical procedure. A 24-hour urine sample was collected as two separate 12hour AM and PM samples. In addition, two spot samples (AM and PM) were taken during each 12hour sample collection period. Analysis of the urinary protein and creatinine was done with a Roche/Hitachi Modular System (Roche Diagnostics, IN, USA). SPSS version 19 was used to analyse the data to make inferences. RESULTS: Thirty Afro-Caribbean persons participated in the study: 16 females and 14 males. The average age and body mass index (BMI) were 38 ± 17 years and 25.32 ± 5.98 kg/m², respectively. The Spearman Rho's correlation was used to interpret associations of the urinary parameters in 24-hour collected sample and the other samples. The strongest correlation of the protein:creatinine ratio in the 24-hour collected sample to the other samples was observed with the 12hour AM sample (r = + 0.743, p < 0.01) followed by the 12hour PM sample (r = +0.672, p < 0.01). On analysing gender, the more significant correlations found were among the males for the 12hour timed samples with r = +0.945, p < 0.01 and r = +0.736, p < 0.01 for the AM and PM samples, respectively. There were very strong correlations between the 24-hour urinary protein excretion and the estimated 24-hour protein excretion from the 12hour AM and PM samples (r = +0.846, p < 0.01 and r = +0.637, p < 0.01, respectively). Both males and females had the strongest correlation for the estimation of 24-hour protein excretion in the 12hour AM sample (r = +0.795, p < 0.01 and r = +0.965, p < 0.01, respectively). CONCLUSION: The use of a 12hour timed sample, specifically the morning sample, may be a more convenient way to assess proteinuria in the Afro-Caribbean population. This method allows for a quicker assessment of proteinuria which not only allows earlier diagnosis of renal disease but may also reduce the clinical cost of the disease's management.

OBJETIVO: La regla de oro para la determinación de la proteinuria - un factor de riesgo independiente para las enfermedades cardiovasculares y renales - es la medición de la proteína en una recogida de la orina de 24 horas. Ha quedado demostrado que este método es poco confiable debido principalmente al pobre cumplimiento del muestreo por parte de los pacientes. Este estudio investiga otros medios adecuados para predecir la excreción urinaria de 24 horas de proteínas en los afrocaribeños de Barbados, evaluando la correlación real y estimada de la excreción urinaria de proteínas entre una muestra de recogida de orina de 24 horas, 12 horas (AM y PM) y las recogidas de orina al azar (AM y PM). SUJETOS Y MÉTODOS: Una muestra conveniente de 30 participantes sanos de origen afrocaribeño de edades entre 21 y 55 años fue reclutada para el estudio. Se obtuvieron muestras de orina de 24 horas y datos antropométricos como se indica en el procedimiento clínico estándar del estudio. Se recogió una muestra de orina de 24 horas, separadas en dos muestras de 12 horas AM y 12 horas PM. Además, se tomaron dos muestras al azar (AM y PM) durante cada periodo de recogida de muestras de 12 horas. El análisis del proteína urinaria y la creatinina urinaria se realizó con un sistema analítico modular Roche/Hitachi. La versión 19 de SPSS se utilizó para analizar los datos con el fin de hacer inferencias RESULTADOS: Treinta personas afrocaribeñas participaron en el estudio: 16 mujeres y 14 hombres. La edad promedio y el índice de masa corporal (IMC) fueron 38 ± 17 años y 25.32 ± 5.98 kg/m², respectivamente. La correlación Spearman Rho fue utilizada para interpretar las asociaciones de los parámetros urinarios en la muestra recogida de 24 horas y las otras muestras. La correlación más fuerte de la relación proteína: creatinina en la muestra recogida de 24 horas con respecto a las otras muestras, se observó en la muestra de 12 horas AM (r = +0.743, p < 0.01), seguida por la muestra de la 12 horas PM (r = +0.672, p < 0.01). En el análisis de género, las correlaciones más significativas fueron aquellas encontradas entre los varones para las muestras cronometradas de 12 horas con r = +0.945, p < 0.01 y r = +0.736, p < 0.01 para las muestras de AM y PM, respectivamente. Hubo correlaciones muy fuertes entre la excreción de proteína urinaria de 24 horas y la excreción de proteína de 24 horas estimada de las muestras de 12 horas AM y PM (r = +0.846, p < 0.01 y r = +0.637, p < 0.01, respectivamente). Tanto los varones como las hembras mostraron una fuerte correlación con respecto al estimado de la excreción proteica de 24 horas en la muestra de 12 horas (r = +0.795, p < 0.01 and r = +0.965, p < 0.01, respectivamente). CONCLUSIÓN: El uso de muestras cronometradas de 12 horas - específicamente la muestra de la mañana - puede ser una manera más conveniente de evaluar la proteinuria en la población afrocaribeña. Este método permite una evaluación más rápida de la proteinuria, la cual no solamente permite un diagnóstico más temprano de la enfermedad renal, sino que también hace posible reducir el costo clínico del tratamiento de la enfermedad.

Serum lipid levels in pregnancies complicated by preeclampsia / Concentrações séricas de lipídeos em gestações com complicações de pré-eclâmpsia

CONTEXT AND OBJECTIVE: Pre-eclampsia is a disorder that occurs only during pregnancy. Postpartum changes relating to lipid metabolism may contribute towards the endothelial lesions observed in preeclampsia. Thus, the aim of the present study was to evaluate the lipid profile among patients who present preeclampsia and correlate these parameters with 24-hour proteinuria. DESIGN AND SETTING: Cross-sectional analytical study including 77 pregnant patients seen at Hospital Dório Silva. METHODS: This study involved 42 women with preeclampsia and 35 healthy pregnant women in the third trimester of pregnancy as controls. Blood samples were obtained from all the patients, and the serum levels of triglycerides, total cholesterol, low-density lipoproteins (LDL), high-density lipoproteins (HDL) and very low density lipoproteins (VLDL) were determined. Cases and controls were matched for maternal age, gestational week and body mass index. RESULTS: The VLDL and triglyceride values from the women with preeclampsia were significantly higher than those of the healthy women. There was a positive correlation between increased proteinuria and higher VLDL and triglyceride levels in patients with preeclampsia. CONCLUSION: Among the patients with preeclampsia, higher VLDL and triglyceride levels were positively correlated with proteinuria. These observations indicate that the pregnant women who presented elevated lipid levels were more susceptible to cardiovascular disorders and, consequently, pre-eclampsia.

CONTEXTO E OBJETIVO: A pré-eclâmpsia é um distúrbio que ocorre apenas durante a gravidez e as alterações pós-parto relacionadas ao metabolismo lipídico podem contribuir para a lesão endotelial observada nessa afecção. Assim, o objetivo do presente estudo foi avaliar o perfil lipídico em pacientes que apresentaram pré-eclâmpsia e correlacionar estes parâmetros com a proteinúria de 24 horas. TIPO DE ESTUDO E LOCAL: Estudo transversal analítico, incluindo 77 pacientes grávidas atendidas no Hospital Dório Silva. MÉTODOS: Este estudo envolveu 42 mulheres com pré-eclâmpsia e 35 gestantes saudáveis no terceiro trimestre de gravidez como controle. Amostras de sangue foram obtidas de todas as pacientes e os níveis séricos de triglicérides, colesterol total, lipoproteínas de baixa densidade (LDL), lipoproteínas de alta densidade (HDL) e lipoproteínas de muito baixa densidade (VLDL) foram determinados. Casos e controles foram pareados por idade materna, semana gestacional e índice de massa corporal. RESULTADOS: Os valores de VLDL e triglicérides, obtidos de mulheres com pré-eclâmpsia foram significativamente maiores quando comparados com mulheres saudáveis. Houve uma correlação positiva entre o aumento da proteinúria e concentrações elevadas de VLDL e triglicérides, em pacientes com pré-eclâmpsia. CONCLUSÃO: Nas pacientes com pré-eclâmpsia foram observadas as maiores concentrações de VLDL e os níveis de triglicérides estão correlacionados positivamente com proteinúria. Estas observações indicam que as mulheres grávidas que apresentam níveis elevados de lipídios, são mais suscetíveis a doenças cardiovasculares e, consequentemente, a pré-eclâmpsia.

Função renal e proteinúria antes e após a doação de rim / Renal function and proteinuria before and after kidney donation

Introdução: Em estudos clínicos, doação de rim para transplante intervivos foi considerada como um procedimento com riscos mínimos a longo prazo paraos doadores, mas os efeitos da redução de massa renal não estão ainda bem definidos. Curiosamente, vários estudos publicados comparam o clearancede creatinina (ClCr) e proteína urinária excretada (PUE) obtidos em doadores antes (dois rins) e após (um rim) a nefrectomia sem considerar os valoresrelativos a um único rim. Metodologia: Nós comparamos a ClCr e PUE, antes e depois da nefrectomia em 21 doadores. Definimos que as metades dosvalores do ClCr e PUE obtidos antes da nefrectomia foram consideradas os valores presumíveis de cada rim, ClCr/2 e PUE/2, respectivamente. O ClCr foicalculado usando a fórmula de Cockcroft-Gault e a PUE foi medida usando urina coletada em 24 horas antes e depois de doação de rim. Resultados: Osresultados demonstram que o ClCr/2 aumentou de 51 ± 2,4 para 78 ± 3,8 ml/min por rim (p <0,0001), e a PUE/2 aumentou de 34,0 ± 3,5 para 205,4 ± 34,0mg/24hs por rim (p <0,0001). Conclusão: Nós concluímos que a hiperfiltração está presente no rim remanescente após a doação. Após a nefrectomia ototal de proteína excretada ainda permanece dentro dos valores considerados normais, mas é importante notar que esta excreção é feita agora através desomente um rim e representa um aumento aproximado de seis vezes dos valores iniciais.

Introduction: In clinical studies, kidney donation for living-related allograft transplantation has been reported as a procedure with minimal long-term risk forthe donors, but the effects of reduced renal mass have not been defined yet. Curiously, many clinical published studies compare creatinine clearence (CrCl)an urinary protein excretion (UPE) obtained in donors before (two kidneys) and after (one kidney) nephrectomy without concerning to the values for eachone kidney. Method: We compared the CrCl and UPE, before and after nephrectomy in 21 donors. We the half of the values for CrCl and UPE obtainedbefore nephrectomy as the presumable initial value for each kidney (CrCl/2 and UPE/2, respectively). The CrCl was estimated by using Cockcroft-Gaultformula and the UPE was measured using urine collected in 24 hours before and after kidney donation. Results: Our results demonstrated that CrCl/2increased from 51 ± 2.4 to 78 ± 3.8 ml/min per kidney (p<0.0001), and the UPE/2 increased from 34.0 ± 3.5 to 205.4 ± 34.0 mg/24hs per kidney (p<0.0001).Conclusion: We conclude that hyperfiltration in the remaining kidney is present after donation and is associated with a considerable increase in the UPEby each kidney. After nephrectomy, the total amount of protein excreted is in the normal range but what calls the attention is the fact that it represents asix-fold increase in protein excretion for the remnant kidney.

Streptozotocin induced hyperglycemia is decreased by nitric oxide inhibition

1. Diabetes mellitus type 1 was induced in 3-month old maleC57 BL/KS-mdb mice (N = 24)) by ip injection of streptozotocin (STZ, 45 mg/Kg body weight) for 5 days. 2. To determine the possible protective effects of nitric oxide inhibition against hyperglycemia, the STZ-diabetic rats received two doses of Ng-nitro-l-arginine-methyl ester (L-NAME) (10 mg/Kg body weight and 10 mg/mouse) dissolved in PBS for 45 consecutive days. Another group of STZ-treated rats was similarly treated with L-arginine (5 mg/mouse). 3. Blood glucose levels were 118 ñ 37 mg/dl after 8 days of L-NAME administration (10 mg/Kg body weight, N = 12) and 186 ñ 22 mg/dl (N = 12) after 5 days of L-NAME administration at the 5 mg/mouse dose. Treatment with L-arginine (5-mg/mouse, N = 12) caused a significant increase in blood glucose level to 151 ñ 17,5 mg/dl, showing the relevance of nitric oxide formation in this type of diabetes. 4. In STZ-diabetic mice treated with L-NAME (N = 12), diuresis was reduced by approximately 58 per cents compared to STZ animals, whereas in L-arginine-treated animals (N = 12) diuresis returned to STZ levels. Urinary protein excretion, which, was significantly affected by STZ (123 per cents compared to control) was significanty reduced by 66 per cents after treatment with L-NAME for 45 days, whereas treatment with-L-arginine caused a return to STZ values. 5. Urinary kallikrein excretion, which was reduced by 80 per cents in STZ mice compared to control, returned to control levels after L-NAME treatment. 6. The present results suggest a relationship between nitric oxide levels and the reduction of diabetic state improved renal function by L-name