Abstract
Diabetes and chronic kidney disease are among the fastest-growing causes of death worldwide. An optimized conceptual framework on the pathogenesis of diabetic kidney disease and its ...interplay with cardiovascular disease will facilitate the development of monitoring and therapeutic strategies to decrease the risk for severe clinical events and early mortality. In this issue of ckj, Pinier et al. provide data supporting the existence in diabetic patients of a single cardiorenal syndrome umbrella, rather than separate cardiorenal or renocardiac entities (e.g. acute cardiorenal syndrome or chronic renocardiac syndromes).
Gran parte de la información médica que se deriva de la práctica clínica habitual queda recogida en forma de lenguaje natural en los informes médicos. Clásicamente, la extracción de información ...clínica para su posterior análisis a partir de los informes médicos requiere de la lectura y revisión manual de cada uno de ellos con la consiguiente inversión de tiempo. El objetivo de este proyecto piloto ha sido evaluar la utilidad de la folksonomía para la extracción y análisis rápido de los datos que contienen los informes médicos.
En este proyecto piloto hemos utilizado la folksonomía para el análisis y la rápida extracción de datos de 1.631 informes médicos de alta de hospitalización del Servicio de Nefrología del Hospital del Mar sin necesidad de crear una base de datos estructurada previamente.
A partir de determinadas preguntas sobre la práctica médica habitual (tratamiento hipoglicemiante de los pacientes diabéticos, tratamiento antihipertensivo y manejo de los inhibidores del sistema renina angiotensina durante el ingreso en nefrología y análisis de datos relacionados con la esfera emocional de los pacientes renales) la herramienta ha permitido estructurar y analizar la información contenida en texto libre en los informes de alta.
La aplicación de folksonomía a los informes médicos nos permite transformar la información contenida en lenguaje natural en una serie de datos estructurados y analizables de manera automática sin necesidad de proceder a la revisión manual de los mismos.
A huge amount of clinical data is daily generated and it is usually filed in clinical reports as natural language. Data extraction and further analysis requires reading and manual review of each report, which is a time consuming process. With the aim to test folksonomy to quickly obtain and analyze the information contained in medial reports we set up this study.
We have used folksonomy to quickly obtain and analyse data from 1631 discharge clinical reports from Nephrology Department of Hospital del Mar, without the need to create an structured database.
After posing some questions related to daily clinical practice (hypoglycaemic drugs used in diabetic patients, antihypertensive drugs and the use of renin angiotensin blockers during hospitalisation in the nephrology department and data related to emotional environment of patients with chronic kidney disease) this tool has allowed the conversion of unstructured information in natural language into a structured pool of data for its further analysis.
Folksonomy allows the conversion of the information contained in clinical reports as natural language into a pool of structured data which can be further easily analysed without the need of the classical manual review of the reports.
Disintegrin and metalloproteinase domain 17 (ADAM17) activates inflammatory and fibrotic processes through the shedding of various molecules such as Tumor Necrosis Factor-α (TNF-α) or Transforming ...Growht Factor-α (TGF-α). There is a well-recognised link between TNF-α, obesity, inflammation, and diabetes. In physiological situations, ADAM17 is expressed mainly in the distal tubular cell while, in renal damage, its expression increases throughout the kidney including the endothelium. The aim of this study was to characterize, for the first time, an experimental mouse model fed a high-fat diet (HFD) with a specific deletion of
in endothelial cells and to analyse the effects on different renal structures. Endothelial
knockout male mice and their controls were fed a high-fat diet, to induce obesity, or standard rodent chow, for 22 weeks. Glucose tolerance, urinary albumin-to-creatinine ratio, renal histology, macrophage infiltration, and galectin-3 levels were evaluated. Results showed that obese mice presented higher blood glucose levels, dysregulated glucose homeostasis, and higher body weight compared to control mice. In addition, obese wild-type mice presented an increased albumin-to-creatinine ratio; greater glomerular size and mesangial matrix expansion; and tubular fibrosis with increased galectin-3 expression.
deletion decreased the albumin-to-creatinine ratio, glomerular mesangial index, and tubular galectin-3 expression. Moreover, macrophage infiltration in the glomeruli of obese
knockout mice was reduced as compared to obese wild-type mice. In conclusion, the expression of ADAM17 in endothelial cells impacted renal inflammation, modulating the renal function and histology in an obese pre-diabetic mouse model.
Acute and chronic kidney lesions induce an increase in A Disintegrin And Metalloproteinase domain 17 (ADAM17) that cleaves several transmembrane proteins related to inflammatory and fibrotic ...pathways. Our group has demonstrated that renal ADAM17 is upregulated in diabetic mice and its inhibition decreases renal inflammation and fibrosis. The purpose of the present study was to analyze how
deletion in proximal tubules affects different renal structures in an obese mice model. Tubular
knockout male mice and their controls were fed a high-fat diet (HFD) for 22 weeks. Glucose tolerance, urinary albumin-to-creatinine ratio, renal histology, and pro-inflammatory and pro-fibrotic markers were evaluated. Results showed that wild-type mice fed an HFD became obese with glucose intolerance and renal histological alterations mimicking a pre-diabetic condition; consequently, greater glomerular size and mesangial expansion were observed.
tubular deletion improved glucose tolerance and protected animals against glomerular injury and prevented podocyte loss in HFD mice. In addition, HFD mice showed more glomerular macrophages and collagen accumulation, which was prevented by
deletion. Galectin-3 expression increased in the proximal tubules and glomeruli of HFD mice and ameliorated with
deletion. In conclusion,
in proximal tubules influences glucose tolerance and participates in the kidney injury in an obese pre-diabetic murine model. The role of ADAM17 in the tubule impacts on glomerular inflammation and fibrosis.
La obesidad está asociada con la hipertensión arterial por mecanismos diversos. La presión arterial (PA) central parece estar más correlacionada que la PA periférica con el riesgo cardiovascular ...futuro. La cirugía bariátrica constituye un método eficaz para disminuir la PA paralelamente a una pérdida de peso significativa en pacientes con obesidad severa. El estudio de la relación entre la modificación de peso tras cirugía bariátrica y la medición ambulatoria de PA, no solo a nivel periférico, sino también a nivel central, podría aportar información respecto a los mecanismos del daño orgánico asociado a la PA elevada en la obesidad.
En esta revisión analizamos la evidencia disponible respecto a la asociación entre la PA central con la obesidad y sus modificaciones tras la cirugía bariátrica.
Various mechanisms are related to arterial hypertension in obesity. Central blood pressure (BP) seems to correlate more than peripheral BP with future cardiovascular risk. Bariatric surgery is an effective method to reduce BP along with weight loss in patients with morbid obesity.
The study of the relationship between weight modification after bariatric surgery and ambulatory BP measurement, not only peripheral BP, but also central BP, could provide information regarding the mechanisms of organic damage associated with elevated BP in obesity.
In this review we analyze the available evidence regarding the association between central BP with obesity and its modifications after bariatric surgery.
Abstract The mode of action of rabbit antithymocyte globulin (rATG) includes preferential inhibition of pre-existing donor-reactive memory T-cell reconstitution and possibly apoptosis of plasma ...cells, the source of donor specific antibodies (DSAs). In kidney transplant patients with low-strength preformed DSAs, non-comparative data have shown a low incidence of antibody-mediated rejection (ABMR) and graft survival using rATG even without desensitization procedures. For high strengths of preformed DSAs, rATG induction with more aggressive desensitization appears effective, with mixed results concerning the addition of B-cell specific agents. Regarding production of de novo DSA (dnDSA), interpretation of retrospective analyses is limited by selective use of rATG in higher-risk patients. Observational data in moderately sensitized kidney transplant patients suggest that the incidence of dnDSA and ABMR is significantly lower with rATG versus basiliximab. A randomized pilot study has suggested that addition of rituximab or bortezomib may not further inhibit dnDSA production in rATG-treated patients. Overall, rATG appears to inhibit DSA production, with a potential role in reducing the risk of ABMR in kidney transplant patients with high-strength preformed DSA, or lowering dnDSA in moderately sensitized patients. Randomized trials are awaited.
Increased intra-abdominal pressure (IAP) is common among post-surgical patients and may cause organ dysfunction. However, its impact after kidney transplantation on early postoperative complications ...and graft recovery remains unclear. We designed a prospective, observational cohort study to describe the prevalence and determinants of IAP, as well as its effect on delayed graft function, postoperative complications, and graft recovery. IAP was measured in 205 kidney transplant recipients every 8 h during the first 72 h after surgery using the urinary bladder technique. Intra-abdominal hypertension was defined as IAP ≥ 12 mmHg. Patients were followed for 6 months or until graft failure/death. Mean IAP was 12 ± 3.3 mmHg within the first 24 h. 78% of subjects presented with intra-abdominal hypertension during the first 72 h. Increased IAP was associated with higher renal resistive index r = 0.213; P = 0.003 and lower urine output r = - 0.237; P < 0.001. 72 h mean IAP was an independent risk factor for delayed graft function OR: 1.31; 95% CI: 1.13-1.51, postoperative complications OR: 1.17; 95% CI: 1.03-1.33, and absence of graft function recovery HR for graft function recovery: 0.94; 95% CI: 0.88-0.99. Increased IAP was highly prevalent after transplantation and was independently associated with delayed graft function, postoperative complications, and absence of graft function recovery. Routine IAP monitoring should be considered post-transplantation to facilitate early recognition of relevant complications.
Abstract
Background
Publications from the last decade have increased knowledge regarding long-term risks after kidney donation. We wanted to perform a survey to assess how transplant professionals in ...Europe inform potential kidney donors regarding long-term risks. The objectives of the survey were to determine how they inform donors and to what extent, and to evaluate the degree of variation.
Methods
All transplant professionals involved in the evaluation process were considered eligible, regardless of the type of profession. The survey was dispatched as a link to a web-based survey. The subjects included questions on demographics, the information policy of the respondent and the use of risk calculators, including the difference of relative and absolute risks and how the respondents themselves understood these risks.
Results
The main finding was a large variation in how often different long-term risks were discussed with the potential donors, i.e. from always to never. Eighty percent of respondents stated that they always discuss the risk of end-stage renal disease, while 56% of respondents stated that they always discuss the risk of preeclampsia. Twenty percent of respondents answered correctly regarding the relationship between absolute and relative risks for rare outcomes.
Conclusions
The use of written information and checklists should be encouraged. This may improve standardization regarding the information provided to potential living kidney donors in Europe. There is a need for information and education among European transplant professionals regarding long-term risks after kidney donation and how to interpret and present these risks.
Angiotensin converting enzyme 2 (ACE2) is a host ectopeptidase and the receptor for the SARS-CoV-2 virus, albeit virus-ACE2 interaction goes far beyond viral entry into target cells. Controversial ...data exists linking viral infection to changes in ACE2 expression and function, which might influence the subsequent induction of an inflammatory response. Here, we tested the significance of soluble ACE2 enzymatic activity longitudinally in nasopharyngeal swabs and plasma samples of SARS-CoV-2 infected patients, along with the induction of inflammatory cytokines. Release of soluble functional ACE2 increases upon SARS-CoV-2 infection in swabs and plasma of infected patients, albeit rapidly decreasing during infection course in parallel with ACE2 gene expression. Similarly, SARS-CoV-2 infection also induced the expression of inflammatory cytokines. These changes positively correlated with the viral load. Overall, our results demonstrate the existence of mechanisms by which SARS-CoV-2 modulates ACE2 expression and function, intracellular viral sensing and subsequent inflammatory response, offering new insights into ACE2 dynamics in the human upper respiratory tract and pointing towards soluble ACE2 levels as a putative early biomarker of infection severity.
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