Renal Osteodystrophy-Time for Common Nomenclature.

PURPOSE OF REVIEW: The term renal osteodystrophy has been used to describe a wide variety of bone problems facing patients with chronic kidney disease (CKD). Here, we review the history of the use of this term. RECENT FINDINGS: Bone disease resulting from CKD was first noticed in 1890. The term "renal osteodystrophy" was used to define the bone disease in 1942. Since then, important discoveries have increased our knowledge of the complexities of bone physiology in these patients. At the same time, secular changes in the disease have occurred. The terms used to describe the bone histological findings have changed as well, reflecting new understanding of the physiological processes. However, since different investigators used the terms in different ways, the need to standardize the nomenclature has become increasingly important. Ongoing international collaboration about nosography will allow more optimal communication among scientists and clinicians as we continue to make new discoveries.

Estimation of chronic kidney disease incidence from prevalence and mortality data in American Indians with type 2 diabetes.

The objective was to estimate chronic kidney disease (CKD) incidence rates from prevalence and mortality data, and compare the estimates with observed (true) incidence rates in a well-characterized population with diabetes. Pima Indians aged 20 years and older with type 2 diabetes were followed from 1982 through 2007. CKD was defined by estimated GFR (eGFR) <60 ml/min/1.72 m2 or albumin-to-creatinine ratio (ACR) ≥30 mg/g. True CKD incidence and mortality rates were computed for the whole study period, and prevalence for the intervals 1982-1994 and 1995-2007. Estimated age-sex stratified CKD incidence rates were computed using illness-death models of the observed prevalences, and of the whole-period mortality rate ratio of CKD to non-CKD persons. Among 1201 participants, 616 incident events of CKD occurred during a median follow-up of 5.6 years. Observed CKD prevalence was 56.9% (95%CI 53.7-60.0) and 48.0% (95%CI 45.2-50.8) in women; 54.0% (95%CI 49.9-58.1) and 49.6% (95%CI 46.0-53.3) in men, across the two periods. Mortality rate was 2.5 (95%CI 1.9-3.3) times as high in women with CKD and 1.6 (95%CI 1.3-2.1) times as high in men with CKD, compared to women or men without CKD. In women, estimated CKD incidence increased linearly from 25.6 (95%CI 4.2-53.0) to 128.6 (95%CI 77.1-196.6) with each 5-year age group up to 69 years, and to 99.8 (95%CI 38.7-204.7) at age ≥70. In men, estimated CKD incidence increased form 28.5 (95%CI 3.8-71.2) at age 20-24 years to 118.7 (95%CI 23.6-336.7) at age ≥70. Age-sex-stratified estimated incidence reflected the magnitude and directional trend of the true incidence and were similar to the true incidence rates (p>0.05 for difference) except for age 20-24 in women (p = 0.008) and age 25-29 in men (p = 0.002). In conclusion, the estimated and observed incidence rates of CKD agree well over 25 years of observation in this well characterized population with type 2 diabetes.

First Occurrence of Diabetes, Chronic Kidney Disease, and Hypertension Among North American HIV-Infected Adults, 2000-2013.

Background: There remains concern regarding the occurrence of noncommunicable diseases (NCDs) among individuals aging with human immunodeficiency virus (HIV), but few studies have described whether disparities between demographic subgroups are present among individuals on antiretroviral therapy (ART) with access to care. Methods: We assessed the first documented occurrence of type 2 diabetes mellitus (DM), chronic kidney disease (CKD), and treated hypertension (HTN) by age, sex, and race within the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). HIV-infected adults (≥18 years) who initiated ART were observed for first NCD occurrence between 1 January 2000 and 31 December 2013. Cumulative incidences as of age 70 were estimated accounting for the competing risk of death; Poisson regression was used to compare rates of NCD occurrence by demographic subgroup. Results: We included >50000 persons with >250000 person-years of follow-up. Median follow-up was 4.7 (interquartile range, 2.4­8.1) years. Rates of first occurrence (per 100 person-years) were 1.2 for DM, 0.6 for CKD, and 2.6 for HTN. Relative to non-black women, the cumulative incidences were increased in black women (68% vs 51% for HTN, 52% vs 41% for DM, and 38% vs 35% for CKD; all P < .001); this disparity was also found among men (73% vs 60% for HTN, 44% vs 34% for DM, and 30% vs 25% for CKD; all P < .001). Conclusions: Racial disparities in the occurrence of DM, CKD, and HTN emphasize the need for prevention and treatment options for these HIV populations receiving care in North America.

Research on kidney and mineral metabolism in Japan: past, present, and future.

Since the identification of the kidney was the main site for the synthesis of calcitriol (1α, 25-dihydroxycholecalciferol), research on chronic kidney disease (CKD)-associated mineral metabolism disorders and their management has made rapid progress. Various active analogues of calcitriol have clinically become available for treating secondary hyperparathyroidism (SHPT), which is a representative mineral metabolism abnormality in CKD patients. A calcimimetic compound cinacalcet hydrochloride has also been developed for the medical management of SHPT through a different mechanism involving the calcium-sensing receptor. The concept of CKD-mineral and bone disorder (CKD-MBD) was proposed in 2006 to provide a comprehensive understanding of a disorder related to mineral metabolism abnormalities of CKD, based on the fact that these abnormalities are closely associated with cardiovascular disease as well as bone disorders (renal osteodystrophy). There has been a recent surge in the development of phosphate binders for CKD-MBD, focused on an effort to improve mortality. In Japan, high-quality basic and clinical research on CKD-MBD has led to the development of novel therapeutic drugs, such as maxacalcitol, falecalcitriol, and bixalomer. New practice guidelines have been published and are widely adapted in clinical practice.

Isaac Albeniz (1860-1909): Spanish musician who died of chronic renal disease.

Isaac Albéniz was a Spanish musician and pianist who was best known in France and England. One of his last works for piano, the suite Iberia, is well-known and identifies his country of origin. He died with terminal uraemia following longstanding chronic intestinal and kidney symptoms. Suggestions as to pathology include amyloidosis complicated by kidney stones and hypertension that sometimes manifested itself in the form of hypertensive crisis, accompanied by obesity.

Chronic kidney disease 10 years on: what have we learned?

PURPOSE OF REVIEW: The aim is to review in broad terms the rapid growth in knowledge and understanding of chronic kidney disease in the key areas of epidemiology, diagnosis and risk prediction in the 10 years since publication of the first formal definition and classification. RECENT FINDINGS: Epidemiological studies that utilized the MDRD equation to estimate glomerular filtration rate (GFR) identified that chronic kidney disease (CKD) was more prevalent than previously appreciated. Considerable effort has been invested in developing more accurate formulae to estimate GFR from serum creatinine and/or cystatin C. There is a growing appreciation of the increased risk of cardiovascular disease and death associated with even small reductions in GFR or mild albuminuria. Risk prediction equations have been developed to assess risk of progression of CKD but these require further validation, and equations to predict the cardiovascular risk associated with CKD are urgently required. SUMMARY: The first 10 years of 'CKD' have been characterized by an unprecedented growth in knowledge and understanding but over the next decade efforts should focus on translating this enhanced knowledge into improved outcomes for the many people now living with this diagnosis.

The renin-angiotensin-aldosterone system in 2011: role in hypertension and chronic kidney disease.

Over the past two decades, considerable advances have been made in our understanding of the renin-angiotensin-aldosterone system (RAAS) and its roles in various disease states. In this review, we will discuss the current state of knowledge of the many components of the RAAS, including new data on prorenin and its receptors, and important angiotensin fragments. The roles of these components of the RAAS in the pathogenesis of primary hypertension and the progression of chronic kidney disease (CKD) will also be highlighted. Given the new understanding of the many components and roles of the RAAS, it may be possible to develop improved therapies for hypertension and CKD.

Evolution of iv iron compounds over the last century.

Administration of intravenous (IV) iron has become pivotal in the management of anaemia in patients with chronic kidney disease (CKD). Since parenteral iron was first introduced for human use in the 1930s, things have come a long way. Seventy years ago, iron was toxic, administered as an iron oxyhydroxide complex. This problem was circumvented with the introduction of compounds containing iron in a core surrounded by a carbohydrate shell. The carbohydrate shell consists of molecules such as dextran, sucrose, dextrin or gluconate. The first dextran-containing IV iron preparations carried a small risk of anaphylaxis, but the more recently introduced low molecular weight iron dextran preparation has significantly less risk of this. Iron reactions occur with all IV iron preparations, but are generally not thought to be immune based. Recently, newer IV iron preparations have appeared in the market, including Ferumoxytol (Feraheme) and ferric carboxymaltose (Ferinject). These latest IV iron preparations do not contain a requirement for a test dose, and a much higher dose of iron can be delivered as a single administration. Thus, giving supplemental iron to man has come a long way since 1930s; we are now in an era when we are able to administer higher doses of iron with acceptable safety and without significant adverse effects. However, the long-term safety of the newer IV iron preparations is not yet established.

Estudo retrospectivo de casos de insuficiência rena crônica em cães no período de 1999 a 2002 / Retrospective study of chronic renal failure cases in dogs between 1999 a 2002

Com o objetivo de compilar e salientar as informações provenientes do histórico clínico, alterações nos exames laboratoriais e no exame ultra-sonográfico que permitam traçar o perf1l clínico dos pacientes, procedeu-se ao estudo retrospectivo de 191 casos de insuficiência renal crônica (IRC) em cães atendidos no período de 3 anos no HOVET / FMVZ - USP. Foram incluídos aqueles que apresentavam concentração sangüínea de uréia >40mg/dL e de creatinina >2 mg/dL. A maioria dos cães tinha idade superior a 7 anos e, entre os cães de raça definida, a raça mais representada foi o Cocker Spaniel, tanto entre os jovens quanto entre os animais de idade mais avançada. Alterações no apetite, êmese, apatia e poliúria/polidipsia foram as principais manifestações clínicas relatadas. Anemia do tipo não regenerativa e hiperfosfatemia foram as alterações mais freqüentes, além daquelas observadas constatadas no exame de urina (densidade urinária baixa, proteinúria e cilindrúria ausente ou em pequena quantidade). As alterações detectadas no exame ultra-sonográfico renal (aumento de ecogenicidade, redução do tamanho, contorno irregular e a diminuição ou ausência do limite córtico-medular) podem trazer informações adicionais para o diagnóstico de nefropatia crônica em cães.

During the period of three years, a retrospective study of 191 dogs with chronic renal failure was performed, in order to describe and focus information concerning history and clinical signs, as well as laboratorial and ultrasound findings, that could help for better understanding of the disease. Dogs included in this study had presented serum concentration levels of urea and creatinin above 40mg/dL and 2mg/dL, respectively. Most of the animals were alder than 7 year-old, and Cocker Spaniel was the main breed observed among young and old affected dogs. Reduction of appetite, vomiting, lethargy, polidipsia and poliuria were the main clinical signs detected. Non-regenerative anemia and hyperphosphatemia, as well as urinalysis (low urinary specific gravity, absent or slight amount of proteinuria and casts in urinary sediment) and ultrasound exam findings (increase in ecogenicity, decrease in size, irregular shape to the renal contour and narrow toward the corticomedullary junction) could help to additional information for the diagnosis of chronic nephropathy in dogs.

Acerca de la muerte del rey Herodes el Grande / About the death of Herod the Great

Herod the Great was the founder of a dynasty that reigned on Judea for several generations. His birth date is estimated on year 73 AC and died at 70 years old. Descriptions of the final disease of Herod were obtained from the classical chronicles of Flavius Josephus, The Jewish war and Jewish Antiquities. A medical explanation for his death is attempted. A parasitism caused by Schistosoma haematobium is suggested as the etiology for chronic renal failure (edema, halitosis and orthopnea) and a "gangrene of genitalia that engendered worms" in the words of Josephus. This would be explained by the formation of genital and urinary fistulae, observed in such disease. The asseveration that Herod was attacked by black bilis is also discussed, based on the concepts of the Hippocratic medicine of that time.

Gerencia del tratamiento de la insuficiencia renal crónica terminal en el seguro social campesino: una propuesta / Management of the treatment of the inadequacy renal terminal chronicle in the rural public health: a proposal

El Seguro Social Campesino en el año 2000 tuvo que disponer de su presupuesto la cantidad de 500,000.00 dólares para el tratamiento de 60 pacientes, lo que determina que solo en la cobertura del Hospital Carlos Marín con 15 pacientes se llegaría a utilizar el 1 por ciento del presupuesto institucional para el tratamiento de Hemodiálisis de un reducido número de pacientes, que si se incrementase al ritmo que vemos en este último año la indidencia de estos costos limitaría otras áreas del programa del Seguro Social Campesino, por lo que es menester llevar un estricto control de estos pacientes, para que su tratamiento sea de un tercer nivel y no se compliquen e incrementen los costos por la urgencia, como también el seguimiento para determinar alternativas como son el transplante renal; siendo el de mayor impacto el aspecto preventivo con una capacitación