Urine Problems
The Not-so-Sweet Truth About Sugar- A Risk Choice?
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More and more people have become aware of the dangers of excessive fructose in diet. A new review on fructose in an upcoming issue of the Journal of the American Society of Nephrology (JASN) indicates just how dangerous this simple sugar may be.
Richard J. Johnson, MD and Takahiko Nakagawa, MD (Division of Renal Diseases and Hypertension, University of Colorado) provide a concise overview of recent clinical and experimental studies to understand how excessive amounts of fructose, present in added sugars, may play a role in high blood pressure, diabetes, obesity, and chronic kidney disease (CKD).
Dietary fructose is present primarily in added dietary sugars, honey, and fruit. Americans most frequently ingest fructose from sucrose, a disaccharide containing 50% fructose and 50% glucose bonded together, and high fructose corn syrup (HFCS), a mixture of free fructose and free glucose, usually in a 55/45 proportion.
New tests and interventions may help prevent future health problems
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1. Potassium Citrate May Help Prevent and Treat Osteoporosis Supplement Neutralizes Bone Damage Inflicted by the Western Diet
The Western diet creates an acidic environment in the body that removes calcium from bones and may contribute to the development of osteoporosis. Healthy adults who consume the standard US diet sustain a chronic, low-grade state of acidosis that worsens with age as kidney function declines, limiting urinary acid excretion. Reto Krapf, MD (University of Basel, in Bruderholz/Basel, Switzerland) and colleagues designed a study to see if daily alkali as potassium citrate supplement tablets might neutralize these effects. They enrolled 201 healthy elderly individuals of both genders with normal bone mass in a randomized double-blind, placebo-controlled clinical trial. Participants received either 60 mmol alkali as potassium citrate (a base) or a placebo every day for 2 years. Bone density and high resolution computed tomography scans after 2 years revealed that neutralizing diet-induced acid production with potassium citrate significantly and safely increased subjects’ bone density vs. placebo. “In addition, we discovered that bone architecture improved significantly, suggesting that not only bone mass, but also its quality was improved,” said Dr. Krapf. These results suggest and predict that potassium citrate may be effective for preventing and even treating osteoporosis.
Study co-authors include Sigrid Jehle, MD (University of Basel, in Bruderholz/Basel, Switzerland) and Henry N. Hulter, MD (FibroGen, Inc., San Francisco).
Disclosures: The authors reported no financial disclosures.
Anemia Tougher to Tackle in Black Children with Kidney Disease
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Black children with chronic kidney disease have more severe anemia than white children even when they receive the same treatment, according to a multicenter study led by Johns Hopkins Children’s Center to be published in the May issue of the American Journal of Kidney Disease.
The findings suggest that inherent biological differences, rather than access to care and treatment, may be at play, raising the question whether current guidelines for anemia treatment should be tailored to reflect race, investigators say.
Anemia, marked by abnormally low levels of red blood cells, is a key indicator of disease status. It is diagnosed by measuring levels of the protein hemoglobin, which carries oxygen in and out of red blood cells.
Drug mistakes common in US kidney dialysis patients
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About 20 percent of kidney dialysis patients who undergo a procedure to open a blocked artery are given the wrong blood clot medicine, increasing the chances of significant bleeding, researchers said on Tuesday.
They said the findings suggest many doctors in the United States ignore warnings on drug labels, often putting patients at risk of serious harm or death.
“The results of this study illustrate the problem of medication errors in the United States, as well as the need to make patient safety a priority on the health care agenda,” Dr. Thomas Tsai of the Denver Veterans Affairs Medical Center and colleagues wrote in the Journal of the American Medical Association.
Heart Test Found Safe for Pre-Transplant Kidney Patients
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A screening test that measures whether a patient’s heart is healthy enough for a kidney transplant is not as dangerous as once thought, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN). The findings indicate that the test, called coronary angiography, does not cause a decline in kidney function for patients with advanced chronic kidney disease (CKD) and can help determine when to schedule a patient for transplantation.
CKD may contribute to the development of heart disease, so physicians keep a close eye on CKD patients’ heart health. However, they are reluctant to perform coronary angiography—which uses dye and x-rays to show the inside of the heart’s arteries—in CKD patients, who are thought to have an increased risk of experiencing complications from the procedure. This is unfortunate because coronary angiography can help determine whether a patient is healthy enough to undergo a kidney transplant.
To determine the true risks of the test for patients with advanced CKD, Nicky Kumar, MBChB, MRCP (West London Renal and Transplant Centre, Imperial College Kidney and Transplant Institute, London), and her colleagues analyzed 76 patients with late stage CKD who were potential transplant recipients seen at their clinics from 2004 to 2007.
Evidence-based guideline ‘Incontinent Urostomy’ published
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The European Association of Urology Nurses (EAUN) presented their ‘Incontinent Urostomy; Good Practice in Health Care’ document last March in Stockholm (Sweden) during the 10th International EAUN meeting, held in conjunction with the 24th Annual EAU Congress.
The aim of this document is to provide the best and most up-to-date information on this topic and thereby assist nurses working in the urological field.
This is the first time ever an evidence-based guidelines document on incontinent urostomy has been published. A multi-disciplinary group of nurses were involved in the development of the text: Hanny Cobussen-Boekhorst (NL), Sharon Fillingham (GB), Sharon Holroyd (GB), Berit Kiesbye (DK), Susanne Vahr (DK) and Veronika Geng (DE).
Protecting Kidney Function During Heart Failure
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Mayo Clinic cardiology researchers have found a peptide that helps preserve and improve kidney function during heart failure, without affecting blood pressure. Earlier variations of this peptide caused blood pressure to drop limiting the potential benefits to the kidneys. The findings appear in the current Proceedings of the National Academy of Sciences.
“Heart failure itself and some of the approaches used to treat it can have detrimental effects on the kidneys,” says Mayo cardiologist and lead researcher Robert Simari, M.D. “Our hope is that this compound will help protect kidney function while you’re being treated, and possibly shorten your hospital stay and keep you out of the hospital.”
This new peptide (a unique link of amino acids) has been tested in the laboratory and in animal models and is expected to move into clinical trials next year.
Some older men may safely stop PSA testing
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Men who are 75-80 years old and have a low prostate specific antigen (PSA) level—that is, less than less than 3 nanograms per milliliter—are unlikely to develop life-threatening prostate cancer during their remaining life span, according to newly reported findings.
“Therefore, these men may represent an ideal target group for discontinuation of PSA testing,” Dr. Edward M. Schaeffer and colleagues conclude in the Journal of Urology.
Such a strategy, they continue, “could dramatically reduce the costs associated with screening,” as well as cutting the risks of the potential complications from “additional evaluations and/or treatment in a population unlikely to experience benefit.”
China probes “mystery” kidney stones in children
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China is baffled by a “drastic” rise in the number of infants falling ill with kidney stones in the wake of a tainted milk scandal which killed six children from kidney complications and made hundreds of thousands ill.
China sentenced two people to death last month for their part in producing or selling milk adulterated with melamine, an industrial compound used to cheat nutrition tests. Nearly 300,000 children fell ill with kidney stones and other kidney-related illnesses from drinking the tainted milk last year.
But a recent rash of kidney complaints in children with apparently no link to drinking milk tainted with melamine had puzzled Chinese health experts and prompted a new investigation, the China Daily said on Thursday, citing the Health Ministry.
Gene Mutation Adds Risk in Child Kidney Transplants
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Screening for mutations in a gene that helps the body metabolize a kidney transplant anti-rejection drug may predict which children are at higher risk for side effects, including compromised white blood cell count or organ rejection, according to new research.
Published online Feb. 18 by the Nature journal Clinical Pharmacology and Therapeutics, the study suggests this genetic approach could also help physicians tailor personalized anti-rejection drug doses to prevent adverse reactions, said senior investigators Alexander A. Vinks, Pharm.D., Ph.D., and Jens Goebel M.D., of Cincinnati Children’s Hospital Medical Center.
“There are better ways than just giving standard doses of these drugs, and in due course these types of technologies will be available worldwide to help patients,” said Dr. Vinks, director of the Division of Clinical Pharmacology and the Pediatric Pharmacology Research Unit at Cincinnati Children’s. “This pilot study shows personalized and prospective MMF dosing and monitoring may be feasible to reduce the high incidence of drug toxicity in children without compromising the drug’s protective effects against kidney graft rejection.”
Protein predicts chronic kidney disease progression
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In patients with chronic kidney disease that has not yet advanced, elevated levels of a protein called neutrophil gelatinase-associated lipocalin (NGAL) in the urine and blood is a strong and independent predictor of disease progression, researchers from Italy report.
Massive amounts of NGAL are released from kidney tubular cells after various injuries to the kidney, Dr. Michele Buemi and colleagues from University of Messina explain in their report published online ahead of print in the Clinical Journal of the American Society of Nephrology.
In a previous study, the researchers found abnormally high levels of this protein in patients who developed kidney disease and impaired kidney function. In addition, patients with higher NGAL levels had a considerably increased risk of worsening kidney function within 1 year compared with those with lower NGAL levels.
Dialysis Patients Residing at Higher Altitude Have Lower Rate of Death
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Compared to dialysis patients living near sea level, dialysis patients living at an altitude higher than 4,000 feet have a 12-15 percent lower rate of death, according to a study in the February 4 issue of JAMA.
A recent study found that patients with end-stage renal (kidney) disease (ESRD) living at higher altitude achieved greater hemoglobin concentrations (a protein in red blood cells that primarily transports oxygen from the lungs to the rest of the body) while receiving lower doses of erythropoietin (a hormone that stimulates the production of red blood cells). Increased iron availability caused by activation of hypoxia-induced (oxygen deficiency) factors at higher altitude may explain this finding, according to background information in the article.
Wolfgang C. Winkelmayer, M.D., Sc.D., of Brigham and Women’s Hospital and Harvard Medical School, Boston, and colleagues examined whether increased altitude would be associated with a reduced rate of death for patients initiating chronic dialysis. Using a comprehensive dialysis registry, the researchers identified 804,812 patients with ESRD who initiated dialysis between 1995 and 2004 and who met the study entry requirements. Most patients resided below an altitude of 250 ft. (40.5 percent) or between 250-1,999 ft. (54.4 percent). Only 1.9 percent of incident dialysis patients lived between 4,000 and 5,999 ft. and 0.4 percent higher than 6,000 ft. Patients were stratified by the average elevation of their residential zip code.
Experts draw link between tainted milk, kidney stones
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Scientists in China and Hong Kong have established for the first time in a study that consuming the plastic-making chemical melamine can cause kidney stones in people.
At least six children died and 290,000 fell ill in China last year after consuming milk formula tainted with melamine, which was added to cheat protein tests. But the causal link between melamine and kidney problems the children suffered was never scientifically established until now.
The experts studied urine samples of 15 mainland Chinese toddlers with kidney stones and compared those taken from 20 children in Hong Kong who also consumed tainted milk but who did not develop stones.
Cystic fibrosis patients’ self-assessment of health can predict prognosis
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Adult Cystic Fibrosis patients can provide important information that helps to predict their prognosis, according to research that asked 223 adult CF patients to assess their own health and well-being.
“We wished to see whether patients themselves had clinically relevant insight to their disease, and we found that they did,” said lead author of the study, Janice Abbott, Ph.D., of the University of Central Lancashire in England.
The study was published in the first issue for January of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.
Metabolic syndrome predicts kidney disease
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Having the so-called metabolic syndrome may raise the risk of chronic kidney disease in people with type 2 diabetes, researchers from China report.
Metabolic syndrome refers to a cluster of risk factors for diabetes and heart disease—including abdominal obesity, high blood pressure, high blood sugar, low levels of “good” HDL cholesterol and high triglycerides (another type of blood fat). The syndrome is typically diagnosed when a person has three or more of these conditions.
The current study suggests that conventional cardiovascular risk factors are also predictors of kidney trouble, Dr. Peter C. Y. Tong from The Chinese University of Hong Kong noted in comments to Reuters Health. “Hence, physicians should actively assess patients with diabetes for these risk factors and treat them aggressively,” Tong said.
