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The Journal of Clinical Endocrinology... Oct 2014Asymptomatic primary hyperparathyroidism (PHPT) is routinely encountered in clinical practices of endocrinology throughout the world. This report distills an update of...
OBJECTIVE
Asymptomatic primary hyperparathyroidism (PHPT) is routinely encountered in clinical practices of endocrinology throughout the world. This report distills an update of current information about diagnostics, clinical features, and management of this disease into a set of revised guidelines.
PARTICIPANTS
Participants, representing an international constituency, with interest and expertise in various facets of asymptomatic PHPT constituted four Workshop Panels that developed key questions to be addressed. They then convened in an open 3-day conference September 19-21, 2013, in Florence, Italy, when a series of presentations and discussions addressed these questions. A smaller subcommittee, the Expert Panel, then met in closed session to reach an evidence-based consensus on how to address the questions and data that were aired in the open forum.
EVIDENCE
Preceding the conference, each question was addressed by a relevant, extensive literature search. All presentations and deliberations of the Workshop Panels and the Expert Panel were based upon the latest information gleaned from this literature search.
CONSENSUS PROCESS
The expert panel considered all the evidence provided by the individual Workshop Panels and then came to consensus.
CONCLUSION
In view of new findings since the last International Workshop on the Management of Asymptomatic PHPT, guidelines for management have been revised. The revised guidelines include: 1) recommendations for more extensive evaluation of the skeletal and renal systems; 2) skeletal and/or renal involvement as determined by further evaluation to become part of the guidelines for surgery; and 3) more specific guidelines for monitoring those who do not meet guidelines for parathyroid surgery. These guidelines should help endocrinologists and surgeons caring for patients with PHPT. A blueprint for future research is proposed to foster additional investigation into issues that remain uncertain or controversial.
Topics: Asymptomatic Diseases; Education; Endocrinology; Evidence-Based Medicine; Humans; Hyperparathyroidism, Primary; Practice Guidelines as Topic
PubMed: 25162665
DOI: 10.1210/jc.2014-1413 -
American Journal of Kidney Diseases :... Jan 2023The safety and efficacy of long-term exercise training in reducing physical functional loss in older adults with advanced CKD and comorbidity is uncertain. (Randomized Controlled Trial)
Randomized Controlled Trial
RATIONALE & OBJECTIVE
The safety and efficacy of long-term exercise training in reducing physical functional loss in older adults with advanced CKD and comorbidity is uncertain.
STUDY DESIGN
Multicenter, parallel group, randomized controlled trial.
SETTINGS & PARTICIPANTS
Adults 55 years and older with estimated glomerular filtration rate (eGFR) of 15 to <45 mL/min/1.73 m enrolled from centers in Baltimore and Boston.
INTERVENTION
Twelve months of in-center supervised exercise training incorporating majority aerobic but also muscle strengthening activities or a group health education control intervention, randomly assigned in 1:1 ratio.
OUTCOME
Primary outcomes were cardiorespiratory fitness and submaximal gait at 6 and 12 months quantified by peak oxygen consumption (Vopeak) on graded exercise treadmill test and distance walked on the 6-minute walk test, respectively. Secondary outcomes were changes in lower extremity function, eGFR, albuminuria, glycemia, blood pressure, and body mass index.
RESULTS
Among 99 participants, the mean age was 68 years, 62% were African American, and the mean eGFR was 33 mL/min/1.73 m; 59% had diabetes, and 29% had coronary artery disease. Among those randomized to exercise, 59% of exercise sessions were attended in the initial 6 months. Exercise was well tolerated without excess occurrence of adverse events. At 6 months, aerobic capacity was higher among exercise participants (17.9 ± 5.5 vs 15.9 ± 7.0 mL/kg/min, P = 0.03), but the differences were not sustained at 12 months. The 6-minute walk distance improved more in the exercise group (adjusted difference: 98 feet [P = 0.02; P = 0.03 for treatment-by-time interaction]). The exercise group had greater improvements on the Timed Up and Go Test (P = 0.04) but not the Short Physical Performance Battery (P = 0.8).
LIMITATIONS
Planned sample size was not reached. Loss to follow-up and dropout were greater than anticipated.
CONCLUSIONS
Among adults aged ≥55 years with CKD stages 3b-4 and a high level of medical comorbidity, a 12-month program of in-center aerobic and resistance exercise training was safe and associated with improvements in physical functioning.
FUNDING
Government grants (National Institutes of Health).
TRIAL REGISTRATION
Registered at ClinicalTrials.gov with study number NCT01462097.
Topics: Humans; Aged; Postural Balance; Time and Motion Studies; Exercise; Physical Functional Performance; Renal Insufficiency, Chronic; Exercise Therapy
PubMed: 35944747
DOI: 10.1053/j.ajkd.2022.06.008 -
Advances in Physiology Education Jun 2018The purpose of this study is to see whether a large drawing of a nephron helped medical students in self-directed learning groups learn renal physiology, histology, and...
The purpose of this study is to see whether a large drawing of a nephron helped medical students in self-directed learning groups learn renal physiology, histology, and pharmacology before discussing clinical cases. The end points were the grades on the renal examination and a student survey. The classes in the fall of 2014 and 2015 used the drawing, but not those of 2012 and 2013. The Charles E. Schmidt College of Medicine at Florida Atlantic University is a newly formed Florida medical school, which enrolled its first class in the fall of 2011. The school relies on self-directed problem-based learning in year 1 and changes over to a case inquiry method in the latter part of year 1 and throughout year 2. At the start of the renal course, each student group received a poster of a nephron with the objective of learning the cell functions of the different nephron parts. During the first year of using the drawing, there was no improvement in grades. After a student suggested adjustment to the drawing, there was a statistically significant difference in the total test score in the second year ( P < 0.001). An unexpected finding was lower grades in all 4 yr in the area of acid-base balance and electrolytes compared with the other four areas tested. In the survey, the students found the drawing useful.
Topics: Education, Medical; Educational Measurement; Female; Histology; Humans; Kidney; Male; Nephrons; Pharmacology; Physiology; Problem-Based Learning; Retrospective Studies; Students, Medical; Teaching; Young Adult
PubMed: 29616568
DOI: 10.1152/advan.00022.2017 -
Frontiers in Endocrinology 2022
Topics: Endocrine System; Endocrinology
PubMed: 36204106
DOI: 10.3389/fendo.2022.1003683 -
Pflugers Archiv : European Journal of... Aug 2022Our kidneys receive about one-fifth of the cardiac output at rest and have a low oxygen extraction ratio, but may sustain, under some conditions, hypoxic injuries that... (Review)
Review
Our kidneys receive about one-fifth of the cardiac output at rest and have a low oxygen extraction ratio, but may sustain, under some conditions, hypoxic injuries that might lead to chronic kidney disease. This is due to large regional variations in renal blood flow and oxygenation, which are the prerequisite for some and the consequence of other kidney functions. The concurrent operation of these functions is reliant on a multitude of neuro-hormonal signaling cascades and feedback loops that also include the regulation of renal blood flow and tissue oxygenation. Starting with open questions on regulatory processes and disease mechanisms, we review herein the literature on renal blood flow and oxygenation. We assess the current understanding of renal blood flow regulation, reasons for disparities in oxygen delivery and consumption, and the consequences of disbalance between O delivery, consumption, and removal. We further consider methods for measuring and computing blood velocity, flow rate, oxygen partial pressure, and related parameters and point out how limitations of these methods constitute important hurdles in this area of research. We conclude that to obtain an integrated understanding of the relation between renal function and renal blood flow and oxygenation, combined experimental and computational modeling studies will be needed.
Topics: Humans; Hypoxia; Kidney; Oxygen; Oxygen Consumption; Renal Circulation
PubMed: 35438336
DOI: 10.1007/s00424-022-02690-y -
Clinical Neurophysiology : Official... Feb 2021Evaluation of disorders of the autonomic nervous system is both an art and a science, calling upon the physician's most astute clinical skills as well as knowledge of... (Review)
Review
Electrodiagnostic assessment of the autonomic nervous system: A consensus statement endorsed by the American Autonomic Society, American Academy of Neurology, and the International Federation of Clinical Neurophysiology.
Evaluation of disorders of the autonomic nervous system is both an art and a science, calling upon the physician's most astute clinical skills as well as knowledge of autonomic neurology and physiology. Over the last three decades, the development of noninvasive clinical tests that assess the function of autonomic nerves, the validation and standardization of these tests, and the growth of a large body of literature characterizing test results in patients with autonomic disorders have equipped clinical practice further with a valuable set of objective tools to assist diagnosis and prognosis. This review, based on current evidence, outlines an international expert consensus set of recommendations to guide clinical electrodiagnostic autonomic testing. Grading and localization of autonomic deficits incorporates scores from sympathetic cardiovascular adrenergic, parasympathetic cardiovagal, and sudomotor testing, as no single test alone is sufficient to diagnose the degree or distribution of autonomic failure. The composite autonomic severity score (CASS) is a useful score of autonomic failure that is normalized for age and gender. Valid indications for autonomic testing include generalized autonomic failure, regional or selective system syndromes of autonomic impairment, peripheral autonomic neuropathy and ganglionopathy, small fiber neuropathy, orthostatic hypotension, orthostatic intolerance, syncope, neurodegenerative disorders, autonomic hyperactivity, and anhidrosis.
Topics: Autonomic Nervous System; Consensus Development Conferences as Topic; Electrodiagnosis; Humans; Neurology; Neurophysiology; Practice Guidelines as Topic; Societies, Medical; Societies, Scientific
PubMed: 33419664
DOI: 10.1016/j.clinph.2020.11.024 -
Current Opinion in Nephrology and... Sep 2019Uromodulin (UMOD), also known as Tamm-Horsfall protein, is the most abundant protein in human urine. UMOD has multiple functions such as protection against urinary tract... (Review)
Review
PURPOSE OF REVIEW
Uromodulin (UMOD), also known as Tamm-Horsfall protein, is the most abundant protein in human urine. UMOD has multiple functions such as protection against urinary tract infections and nephrolithiasis. This review outlines recent progress made in UMOD's role in renal physiology, tubular transport, and mineral metabolism.
RECENT FINDINGS
UMOD is mostly secreted in the thick ascending limb (TAL) and to a lesser degree in the distal convoluted tubule (DCT). UMOD secretion is regulated by the calcium-sensing receptor. UMOD upregulates ion channels [e.g., renal outer medullary potassium channel, transient receptor potential cation channel subfamily V member 5, and transient receptor potential melastatin 6 (TRPM6)] and cotransporters [e.g., Na,K,2Cl cotransporter (NKCC2) and sodium-chloride cotransporter (NCC)] in the TAL and DCT. Higher serum UMOD concentrations have been associated with higher renal function and preserved renal reserve. Higher serum UMOD has also been linked to a lower risk of cardiovascular disease and diabetes mellitus.
SUMMARY
With better serum UMOD detection assays the extent of different functions for UMOD is still expanding. Urinary UMOD regulates different tubular ion channels and cotransporters. Variations of urinary UMOD secretion can so contribute to common disorders such as hypertension or nephrolithiasis.
Topics: Animals; Calcium; Humans; Hypertension; Ion Transport; Kidney Tubules; Magnesium; Minerals; Renal Insufficiency, Chronic; Uromodulin
PubMed: 31205055
DOI: 10.1097/MNH.0000000000000522 -
Diseases (Basel, Switzerland) Sep 2021Melatonin functions as a central regulator of cell and organismal function as well as a neurohormone involved in several processes, e.g., the regulation of the circadian... (Review)
Review
Melatonin functions as a central regulator of cell and organismal function as well as a neurohormone involved in several processes, e.g., the regulation of the circadian rhythm, sleep, aging, oxidative response, and more. As such, it holds immense pharmacological potential. Receptor-mediated melatonin function mainly occurs through MT1 and MT2, conserved amongst mammals. Other melatonin-binding proteins exist. Non-receptor-mediated activities involve regulating the mitochondrial function and antioxidant cascade, which are frequently affected by normal aging as well as disease. Several pathologies display diseased or dysfunctional mitochondria, suggesting melatonin may be used therapeutically. models have extensively been employed to study disease pathogenesis and discover new drugs. Here, we review the multiple functions of melatonin through the lens of functional conservation and model organism research to empower potential melatonin therapeutics to treat neurodegenerative and renal diseases.
PubMed: 34698120
DOI: 10.3390/diseases9040067 -
Seminars in Nephrology Jul 2016Chronic kidney disease (CKD) is highly prevalent in the United States and throughout the world,(1) with approximately 13% of adults affected.(2) In addition, according... (Review)
Review
Chronic kidney disease (CKD) is highly prevalent in the United States and throughout the world,(1) with approximately 13% of adults affected.(2) In addition, according to recent estimates, almost half of patients with CKD stages 3 to 5 are 70 years of age and older.(2) In the United States, the number of prevalent end-stage renal disease cases continues to increase in patients older than age 65. In light of the demographic characteristics of patients with CKD and ESRD, there has been considerable focus on associations between CKD and cardiovascular outcomes.(3) Until recently, less attention had been paid to other consequences of CKD in general and among older individuals with CKD in particular, but there is now solid evidence linking CKD with impairments of physical function, cognitive function, and emotional function and quality of life. This review summarizes available literature on these topics, focusing specifically on physical functioning and frailty, cognitive function, emotional health, including depression and anxiety, and health-related quality of life.
Topics: Activities of Daily Living; Anxiety; Cognition; Cognitive Dysfunction; Depression; Disease Progression; Frailty; Health Status; Humans; Kidney Failure, Chronic; Mental Health; Quality of Life; Renal Insufficiency, Chronic
PubMed: 27475661
DOI: 10.1016/j.semnephrol.2016.05.007 -
Seminars in Cell & Developmental Biology Jul 2019The kidney vasculature has a unique and complex architecture that is central for the kidney to exert its multiple and essential physiological functions with the ultimate... (Review)
Review
The kidney vasculature has a unique and complex architecture that is central for the kidney to exert its multiple and essential physiological functions with the ultimate goal of maintaining homeostasis. An appropriate development and coordinated assembly of the different vascular cell types and their association with the corresponding nephrons is crucial for the generation of a functioning kidney. In this review we provide an overview of the renal vascular anatomy, histology, and current knowledge of the embryological origin and molecular pathways involved in its development. Understanding the cellular and molecular mechanisms involved in renal vascular development is the first step to advance the field of regenerative medicine.
Topics: Animals; Gene Expression Regulation, Developmental; Humans; Kidney; Neovascularization, Physiologic; Nephrons; Regenerative Medicine; Renal Artery; Renal Veins
PubMed: 29879472
DOI: 10.1016/j.semcdb.2018.06.001