Lupus Nephritis Need Not Prevent Renal Transplants

With lupus, the body's immune system targets its own body tissues. Lupus nephritis happens when lupus involves the kidneys. General symptoms of lupus include malar rash, discoid rash, photosensitivity, oral ulcers, nonerosive arthritis, pleuropericarditis, renal disease, neurological manifestations, and haematological disorders. Up to 60 percent of people with SLE are diagnosed with lupus nephritis, which can lead to significant illness and even death.

Investigators reviewed outcomes from adults who had attended a lupus clinic at the Toronto Western Hospital in Toronto, Ontario, from 1970 to 2012. Among the 1,645 lupus patients treated in that interval, 25 had nephritis and underwent kidney transplantation. Most of these patients were white (40%) and African Canadian (28%). The remaining patients were Asian or members of other ethnic groups. None of them had any clinical evidence of lupus in the year before transplantation.

Two of the patients had a completely non-functional kidney post-transplant. Another four had graft failure, one within five years of transplant surgery and the remaining three after a longer period, with an average time to graft failure of 5.75 years. Of the 19 (76%) patients with graft survival, the graft survived at least five years in eight patients, with a mean graft survival among these eight patients of 5.7 years.

The four patients with graft failure and 19 with graft survival had roughly similar characteristics, except that the average age in the graft-survival group was higher (40 vs. 29.8 years). Significantly more whites and African-Canadians had graft survival than graft failure, at seven and one, and six and one, respectively.

In addition, the average time between lupus diagnosis and transplant was 15.5 year in the graft-survival group and 4.5 years in the graft-failure group. The respective average durations of dialysis prior to transplant were 5.8 and 3.9 years.

Three of the individuals in the graft-survival group died an average of 5.6 years post-transplant. The cause of death was not related to renal disease in two patients and unknown in the third. Another patient was lost to follow-up. In the graft-failure group, three patients died an average of six years post-transplant, and all the deaths were related to renal disease. The remaining patient is still living.

One (25%) of four patients in the graft-failure group had positive lupus serology a year before transplantation compared with nine (47%) of 19 patients in the graft-survival group. At one year post-transplant, the proportion of patients with lupus serology in the graft-failure group rose to 66%, while it fell to 42% in the other group.

“I presume that older patients had quiescent lupus disease activity for a longer period compared to the other patients, and it is possible that the severity of lupus disease activity tends to ameliorate [or] weaken years after the diagnosis of lupus,” said lead investigator Zahi Touma, MD, PhD, of the University of Toronto Lupus Clinic at the Toronto Western Hospital, in explaining the results.

In another poster presented at the rheumatology meeting, Dr. Touma and three other co-investigators analyzed the timeframe for either partial (at least 50% decrease from baseline in proteinuria) or complete, recovery from proteinuria in lupus nephritis patients. They determined that partial or complete recovery from proteinuria may be a better end point in clinical studies of this patient population because it tracks parallel to complete response but happens somewhat more quickly, which is an advantage in studies that do not last for decades.

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Mortality in Lupus Patients Does Not Differ By Dialysis Type

Lupus affects mainly the joints, kidneys and skin.  It can affect the skin, joints, kidneys, lungs, nervous system and other organs of the body. These symptoms vary over time in intensity and duration for each patient as well as from patient to patient. Many of these interventions can be modified for the hospitalized patient.

The mortality risk among patients with end-stage renal disease (ESRD) and lupus is similar regardless of their initial dialysis modality, according to a new study.

Gabriel Contreras, MD, of the University of Miami Miller School of Medicine, and colleagues used propensity score matching to create 1,352 matched pairs of patients with ESRD patients and systemic lupus erythematosus (SLE) who started hemodialysis (HD) or peritoneal dialysis (PD). The matched pairs were mostly women (86%) with a median age of 39 years. The median follow-up period was 3 years.

The HD and PD groups had overall mortality rates of 22.5% and 21.4%, respectively, within the first 3 years of observation, a non-significant difference between the groups, investigators reported online ahead of print in the Clinical Journal of the American Society of Nephrology. The matched pairs also had similar cardiovascular-related mortality rates (9.5% in the HD group, 10.5% in the PD group) and infection-related mortality (4.4% in the HD group and 3.0% in the PD group).kidneyhospitalabroad@hotmail.com.

Screen for CKD Among People of Low Socioeconomic Status

In many CKD patients, previous renal disease or other underlying diseases are already known. Screening those who have neither symptoms nor risk factors for CKD is not recommended. The prognosis of patients with chronic kidney disease is guarded as epidemiological data have shown that all cause mortality increases as kidney function decreases.

Screening people of low socioeconomic status for chronic kidney disease (CKD) may prove more valuable than screening seniors, according to Dutch researchers. The study found that people of low socioeconomic status are at higher risk of CKD and its complications, including kidney decline and cardiovascular events, compared to adults older than age 60. For the study, the investigators compared 3 screening approaches in 3,411 individuals:

Traditional CKD screening of people with diabetes, high blood pressure, or a history of cardiovascular disease

Traditional screening with the addition of seniors

Traditional screening with the addition of people of low socioeconomic status (i.e., only a primary school education)

Participants underwent 4 rounds of screening over more than 9 years. The numbers of individuals needed to screen to detect one CKD case were 5.6 in Approach 1 and 6.5 each in Approach 2 and 3. In Approach 2 (seniors), the odds of cardiovascular events were 87 to 92% higher among persons with CKD compared to those without the disease. The odds were more striking in Approach 3 (low income individuals), however: 128 to 231%.

The rate of renal function decline was also faster among low-income individuals than among seniors.Our email is kidneyhospitalabroad@hotmail.com.

CKD is a Gout Risk Factor

Chronic kidney disease is identified by a blood test for creatinine. Chronic kidney disease (CKD) appears to be an independent risk factor for gout, according to American researchers.  Stage 5 CKD is often called end stage renal disease, end stage renal failure, or end-stage kidney disease, and is synonymous with the now outdated terms chronic kidney failure or chronic renal failure.

For the study, investigators observed the development of gout among participants in the Framingham Heart Study 1948-2002.

Using Cox proportional hazard models, the researchers estimated the odds of CKD leading to gout among men and women separately. They adjusted results for other risk factors, including age, alcohol consumption, smoking history, hypertension, diabetes, and body mass index.

According to results published in BMJ Open, the incidence of gout among CKD patients was 6.82 per 1,000 persons per year compared to 2.43 for those without the disease. In multivariable models, CKD was associated with double the odds of gout among men and women.

The study adds to the growing body of epidemiological research supporting the hypothesis that CKD is a risk factor for future gout.

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Proteinuric Diabetic Kidney Disease More Likely in Minorities

Kidney damage from diabetes is called diabetic nephropathy. If the damage continues, your kidneys could fail. Failing kidneys lose their ability to filter out waste products, resulting in kidney disease. In fact, diabetes is the most common cause of kidney failure in the United States. Other complications may be arteriosclerosis of the renal artery and protein in the urine.

Racial and ethnic minorities are more likely than non-Hispanic whites to have proteinuric diabetic kidney disease (DKD), according to new findings published online in Diabetes Care.

In a study of 15,683 individuals by Vivek Ghalla, MD, of Stanford University School of Medicine in Stanford, Calif., and colleagues, Hispanic men and women had a significant 34% and 46% increased odds of proteinuric DKD, respectively, compared with non-Hispanic whites, in adjusted analyses. Chinese men and women had a 56% and 39% increased odds of DKD, and Filipino men and women had an 85% and 57% increased odds. Non-Hispanic black women had a significant 50% increased odds. Our Email is kidneyhospitalabroad@hotmail.com.

Treatment Options for End Stage Renal Disease

We know it is sad for kidney patients be diagnosed as end stage renal disease, which means the kidney function of patients is almost vanish. But you should bear in mind that “heaven never seals off all the exits.” There are still kind of methods to treat the end stage renal disease and the patients also can live a long life by received effective therapies.

Hemodialysis

Hemodialysis uses a dialyzer, or special filter, to clean your blood. The dialyzer connects to a machine. During treatment, your blood travels through tubes into the dialyzer. The dialyzer filters out wastes and extra fluids. Then the newly cleaned blood flows through another set of tubes and back into your body.

Hemodialysis is a procedure that cleans and filters your blood. It can clean your body of harmful wastes, extra salt and fluids. It also controls blood pressure and helps your body keep the proper balance of chemicals such as potassium, sodium, and chloride.

Before your first treatment, an access to your bloodstream must be made. The access provides a way for blood to be carried from your body to the dialysis machine and then back into your body. The access can be internal (inside the body -- usually under your skin) or external (outside the body).

Hemodialysis can be done at home or at a center. At a center, nurses or trained technicians perform the treatment. At home, you perform hemodialysis with the help of a partner, usually a family member or friend. If you decide to do home dialysis, you and your partner will receive special training.

Hemodialysis usually is done three times a week. Each treatment lasts from 2 to 4 hours. During treatment, you can read, write, sleep, talk, or watch TV.

Kidney Transplantation

Kidney transplantation is a procedure that places a healthy kidney from another person into your body. This one new kidney does all the work that your two failed kidneys cannot do.

You may receive a kidney from a member of your family. This kind of donor is called a living-related donor. You may receive a kidney from a person who has recently died. This type of donor is called a cadaver donor. Sometimes a spouse or very close friend may donate a kidney. This kind of donor is called a living-unrelated donor.

It is very important for the donor's blood and tissues to closely match yours. This match will help prevent your body's immune system from fighting off, or rejecting, the new kidney. A lab will do special tests on blood cells to find out if your body will accept the new kidney.

The surgery takes from 3 to 6 hours. The usual hospital stay may last from 10 to 14 days. After you leave the hospital, you will go to the hospital for regular examination.

Stem cells

Stem cells are undifferentiated biological cells that can differentiate into specialized cells and can divide (through mitosis) to produce more stem cells. They are found in multicellular organisms. There are three known accessible sources of autologous adult stem cells in humans:

1. Bone marrow, which requires extraction by harvesting, that is, drilling into bone (typically the femur or iliac crest).

2. Adipose tissue (lipid cells), which requires extraction by liposuction.

3. Blood, which requires extraction through apheresis, where in blood is drawn from the donor (similar to a blood donation), and passed through a machine that extracts the stem cells and returns other portions of the blood to the donor.
Stem cells can also be taken from umbilical cord blood just after birth. Of all stem cell types, autologous harvesting involves the least risk. By definition, autologous cells are obtained from one's own body, just as one may bank his or her own blood for elective surgical procedures.

Potency

Stem cells are categorized by their potential to differentiate into other types of cells. Embryonic stem cells are the most potent since they must become every type of cell in the body. The full classification includes:

1 Totipotent - the ability to differentiate into all possible cell types. Examples are the zygote formed at egg fertilization and the first few cells that result from the division of the zygote.

2 Pluripotent - the ability to differentiate into almost all cell types. Examples include embryonic stem cells and cells that are derived from the mesoderm, endoderm, and ectoderm germ layers that are formed in the beginning stages of embryonic stem cell differentiation.

3 Multipotent - the ability to differentiate into a closely related family of cells. Examples include hematopoietic (adult) stem cells that can become red and white blood cells or platelets.

4 Oligopotent - the ability to differentiate into a few cells. Examples include (adult) lymphoid or myeloid stem cells.

5 Unipotent - the ability to only produce cells of their own type, but have the property of self-renewal required to be labeled a stem cell. Examples include (adult) muscle stem cells.


Don’t be so upset if you are diagnosed the end stage of renal kidney disease. There also are a lot of therapies in our hospital which can remit your pain. if you want to know more information about our therapies you can contact with our online doctors, or send messages to kidneyhospitalabroad@hotmail.com.

Sleep Problems in PKD: Cause and Treatment

Polycystic Kidney Disease (PKD) is an annoying disease which has affected patient’s life seriously. And there are a lot of symptoms along with the PKD patients at all times. For example, the sleep problems are one of the symptoms for PKD patients. It is difficult for patients with PKD to have a high quality sleep, how painful it is. So I believe that every the PKD patient wants to get rid off the sleep problems. Now I will discuses some reasons and treatment to PKD patients, which I hope will be useful.

Causes

1 Enlargement of cysts

We all know that there are numerous of cysts on the kidney of PKD patients, with time going on, the cysts are becoming bigger and bigger which will cause the back pain or abdominal pain. Moreover, when the cysts grow to a certain size, they are easy to rupture. With the kinds of pain, the PKD patients absolutely can lead to sleep problems.

2 Frequent of urination at night

Because of so many cysts grow on the kidney; the kidney function will be declining seriously, which can cause a frequent urination than normal, especially at the night. Imaging that, a few minutes you will go to the wash room, how can you have a good sleep?

3 Mental pressures

If we don’t have a healthy body, we will don’t have a happy life. Once the patients cause PKD they will worry the health all the time. What’s more? There still not a good method to cure he disease, so the PKD patients will bear a heavy mental pressure. They will eat less and sleep less.

Treatment

The poor sleep is a symptom of PKD, so if you want to get rid of the poor sleep you will receive an effective therapy to treat PKD. Now I will share a unique therapy which has gained a high praise among PKD patients.

Micro-Chinese Medical Osmotherapy, an original creation of our hospital, which is making the Chinese medical herbs into tiny powder and put them into two bags. Then we apply the Chinese medical bags on the patient’s skin which is corresponding to the kidney part. With the professional equipment’s help, the active composition penetrate into the kidney part.

The main functions of this therapy are promoting the blood circulations and eliminating the composition of the cysts. Because of cysts cover on the kidney, the kidney can’t absorb the nutrient substance that the body needed and can’t discharge waste normally. When our Chinese medical powder penetrates into the damaged kidney, the kidney cells will be recovered a lot and the kidney vessels will be improved. As well as, the composition of cysts will be absorbed. So the kidney function will be improved gradually.


How do you think our special therapy? We still have other therapies to treat PKD. If you want to get rid of the poor sleep and want to improve your kidney function, you can communicate with our online doctors or send emails to the kidneyhospitalabroad@hotmail.com At last we all hope you will live a better life.