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Current Opinion in Nephrology and... Jul 2022Fibroblast growth factor 23 (FGF23) excess is associated with left ventricular hypertrophy (LVH) and early mortality in patients with chronic kidney disease (CKD) and in... (Review)
Review
PURPOSE OF REVIEW
Fibroblast growth factor 23 (FGF23) excess is associated with left ventricular hypertrophy (LVH) and early mortality in patients with chronic kidney disease (CKD) and in animal models. Elevated Lipocalin-2 (LCN2), produced by the injured kidneys, contributes to CKD progression and might aggravate cardiovascular outcomes. The current review aims to highlight the role of LCN2 in CKD, particularly its interactions with FGF23.
RECENT FINDINGS
Inflammation, disordered iron homeostasis and altered metabolic activity are common complications of CKD, and are associated with elevated levels of kidney-produced LCN2 and bone-secreted FGF23. A recent study shows that elevated LCN2 increases FGF23 production, and contributes to cardiac injury in patients and animals with CKD, whereas LCN2 reduction in mice with CKD reduces FGF23, improves cardiovascular outcomes and prolongs lifespan.
SUMMARY
In this manuscript, we discuss the potential pathophysiological functions of LCN2 as a major kidney-bone crosstalk molecule, linking the progressive decline in kidney function to excessive bone FGF23 production. We also review associations of LCN2 with kidney, cardiovascular and bone and mineral alterations. We conclude that the presented data support the design of novel therapeutic approaches to improve outcomes in CKD.
Topics: Animals; Fibroblast Growth Factors; Humans; Hypertrophy, Left Ventricular; Kidney; Lipocalin-2; Mice; Renal Insufficiency, Chronic
PubMed: 35727169
DOI: 10.1097/MNH.0000000000000804 -
Acta Veterinaria Scandinavica Jan 2021The ultrasonographic examination technique is a well-established, non-invasive diagnostic tool for diverse conditions in humans and different animal species. The purpose...
BACKGROUND
The ultrasonographic examination technique is a well-established, non-invasive diagnostic tool for diverse conditions in humans and different animal species. The purpose of our study was to describe ultrasonographic localisation, sonographic appearance and dimensions of the kidneys and spleen of clinically healthy llamas and alpacas. Differences between llamas and alpacas and the influence of sex and ages were investigated. Results of this study may aid veterinarians performing ultrasonography in diseased animals and the technique can be used for routine protocol screening.
RESULTS
Ultrasonography was performed in 135 clinically healthy, non-sedated llamas and alpacas. Screening was performed with a 6.6 MHz curve linear transducer with only alcohol as contact medium between the probe and unclipped skin. The kidneys could be imaged from the paralumbar region. The right kidney only was visualized when scanning from the right and the left kidney only from the left. While the left kidney appeared in sagittal view as an oval shape in most llamas and alpacas, in one third of animals the left kidney had a triangular shape. The L-shaped base of the spleen, with its homogeneous, echoic pattern, could be seen craniolateral to the left kidney. Anechoic areas displaying vessels inside the spleen and a thin echoic capsule surrounding the splenic tissue could be differentiated. While sonographic appearances of the examined organs showed no differences between llamas and alpacas, selected dimensions of both of kidney and spleen showed significant differences between species. In terms of age and sex, significant differences in respect of kidney size could be found only in alpacas. Sex seemed to have no influence on kidney and spleen sizes in llamas.
CONCLUSIONS
The present study provides species-specific information on ultrasonographic appearance and reference values for kidney and spleen dimensions of clinically healthy llamas and alpacas. Results show differences in organ sizes between llamas and alpacas and in alpacas of different sex and age. The results of this study can be used as references for veterinarians performing ultrasound examinations in diseased animals.
Topics: Animals; Camelids, New World; Female; Kidney; Male; Reference Values; Species Specificity; Spleen; Ultrasonography
PubMed: 33478520
DOI: 10.1186/s13028-021-00571-5 -
BioMed Research International 2021The novel coronavirus disease 2019 (COVID-19) is the cause of an acute respiratory illness which has spread around the world. The virus infects the host by binding to... (Review)
Review
The novel coronavirus disease 2019 (COVID-19) is the cause of an acute respiratory illness which has spread around the world. The virus infects the host by binding to the angiotensin-converting enzyme 2 (ACE2) receptors. Due to the presence of ACE2 receptors in the kidneys and gastrointestinal (GI) tract, kidneys and GI tract damage arising from the virus can be seen in patients and can cause acute conditions such as acute kidney injury (AKI) and digestive problems for the patient. One of the complications of kidneys and GI involvement in COVID-19 is fluid and electrolyte disturbances. The most common ones of these disorders are hyponatremia, hypernatremia, hypokalemia, hypocalcemia, hypochloremia, hypervolemia, and hypovolemia, which if left untreated, cause many problems for patients and even increase mortality. Fluid and electrolyte disturbances are more common in hospitalized and intensive care patients. Children are also at greater risk for fluid and electrolyte disturbances complications. Therefore, clinicians should pay special attention to the fluid and electrolyte status of patients. Changes in fluid and electrolyte levels can be a good indicator of disease progression.
Topics: Acute Kidney Injury; Body Fluids; COVID-19; Electrolytes; Gastrointestinal Tract; Humans; Hypocalcemia; Hypokalemia; Hyponatremia; Kidney
PubMed: 33937408
DOI: 10.1155/2021/6667047 -
Heart Failure Reviews Jul 2015The left ventricular assist device (LVAD) has become an established treatment option for patients with refractory heart failure. Many of these patients experience... (Review)
Review
The left ventricular assist device (LVAD) has become an established treatment option for patients with refractory heart failure. Many of these patients experience chronic kidney disease (CKD) due to chronic cardiorenal syndrome type II, which is often alleviated quickly following LVAD implantation. Nevertheless, reversibility of CKD remains difficult to predict. Interestingly, initial recovery of GFR appears to be transient, being followed by gradual but significant late decline. Nevertheless, GFR often remains elevated compared to preimplant status. Larger GFR increases are followed by a proportionally larger late decline. Several explanations for this gradual decline in renal function after LVAD therapy have been proposed, yet a definitive answer remains elusive. Mortality predictors of LVAD implantation are the occurrence of either postimplantation acute kidney injury (AKI) or preimplant CKD. However, patient outcomes continue to improve as LVAD therapy becomes more widespread, and adverse events including AKI appear to decline. In light of a growing destination therapy population, it is important to understand the cumulative effects of long-term LVAD support on kidney function. Additional research and passage of time are required to further unravel the intricate relationships between the LVAD and the kidney.
Topics: Animals; Cardio-Renal Syndrome; Heart Failure; Heart-Assist Devices; Humans; Kidney; Renal Insufficiency, Chronic; Ventricular Function, Left
PubMed: 25796403
DOI: 10.1007/s10741-015-9481-z -
Clinical Radiology Jul 2022To report the morphology of maternal kidneys captured on fetal magnetic resonance imaging (MRI) including kidney length, volume, renal pelvis diameter, and...
AIM
To report the morphology of maternal kidneys captured on fetal magnetic resonance imaging (MRI) including kidney length, volume, renal pelvis diameter, and corticomedullary differentiation in pregnancy.
MATERIALS AND METHODS
A retrospective study of maternal kidney morphology captured incidentally on fetal MRI. Women without chronic kidney disease, with a complete view of both kidneys and a singleton pregnancy were included. Kidney length, maximal renal pelvis diameter, kidney volume, and corticomedullary differentiation ratio were measured independently in duplicate. Associations with maternal and pregnancy variables were explored using linear regression.
RESULTS
MRI images from 42 women were performed at 22-32 weeks' gestation. Serum creatinine concentrations are not checked routinely during pregnancy and were available for 15 (36%) women, with a median creatinine of 57 μmol/l (IQR: 50-63 μmol/l). Mean interpolar lengths were 10.9 and 10.4 cm for the left and right kidneys and varied with height. Mean maximal renal pelvis diameters were 9 mm and 12 mm, with upper reference intervals of 17 and 25 mm for the left and right kidneys, respectively. Renal volume in pregnancy was within the non-pregnant reference interval and varied with height and gestation.
CONCLUSIONS
Maternal kidney length and volume in pregnancy are within the normal reference intervals for non-pregnant women. Renal pelvis diameter in pregnancy measured using MRI is substantially higher than described previously by ultrasound, with implications for routine reporting.
Topics: Female; Gestational Age; Humans; Kidney; Magnetic Resonance Imaging; Male; Pregnancy; Retrospective Studies; Ultrasonography; Ultrasonography, Prenatal
PubMed: 35570156
DOI: 10.1016/j.crad.2022.03.019 -
Blood Purification 2014The use of left ventricular assist devices (LVADs) in treating patients with advanced heart failure restores cardiac output resulting in improved perfusion to multiple... (Review)
Review
The use of left ventricular assist devices (LVADs) in treating patients with advanced heart failure restores cardiac output resulting in improved perfusion to multiple organ systems with important clinical benefits. Renal pathophysiology during LVAD support remains an evolving, poorly understood, and potentially dynamic problem. Changes in renal function after LVAD placement have been investigated in multiple studies with contradictory results. Renal dysfunction is common prior to LVAD placement, which complicates postoperative clinical outcomes. The purpose of this review is to assess the latest information regarding the effects of LVADs on renal function with regard to hemodynamics, physiology, pathology and clinical issues prior to and after placement of the devices. The review should then aid in identifying patients best suited to benefit from this technology and to refine the therapy to reduce associated risks.
Topics: Acute Kidney Injury; Animals; Heart Ventricles; Heart-Assist Devices; Hemodynamics; Humans; Incidence; Kidney
PubMed: 24525434
DOI: 10.1159/000357970 -
Transplant International : Official... 2022Right-sided living donor kidneys have longer renal arteries and shorter veins that make vascular anastomosis more challenging. We sought to determine whether recipients... (Observational Study)
Observational Study
Right-sided living donor kidneys have longer renal arteries and shorter veins that make vascular anastomosis more challenging. We sought to determine whether recipients of right-sided living donor kidneys have worse outcomes than left-sided kidney recipients. An observational analysis of the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) was undertaken. We used adjusted logistic regression to determine the association between side and delayed graft function (DGF) and time-stratified adjusted cox regression models for graft and patient survivals. Between 2004 and 2018, 4,050 living donor kidney transplants were conducted with 696 (17.2%) using right kidneys. With reference to left kidneys, the adjusted OR (95% CI) for DGF was 2.01 (1.31-3.09) for recipients with right kidneys. Within 30 days, 46 allografts (1.4%) were lost, with major causes of overall graft loss being technical, primary non-function and death. Recipients of right donor kidneys experienced a greater risk of early graft loss (aHR 2.02 [95% CI 1.06-3.86], = 0.03), but not beyond 30 days (aHR 0.97 [95% CI 0.80-1.19], = 0.8]). Technical challenge is the most common cause of early graft loss. The risk of early graft loss among recipients who received right kidneys is doubled compared to those who received left living donor kidneys.
Topics: Graft Rejection; Graft Survival; Humans; Kidney; Kidney Transplantation; Living Donors; Registries; Tissue Donors; Tissue and Organ Harvesting
PubMed: 35444489
DOI: 10.3389/ti.2022.10117 -
BMC Nephrology Nov 2022Changes in renal perfusion may play a pathophysiological role in hypertension and kidney disease, however to date, no method for renal blood flow (RBF) determination in... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Changes in renal perfusion may play a pathophysiological role in hypertension and kidney disease, however to date, no method for renal blood flow (RBF) determination in humans has been implemented in clinical practice. In a previous study, we demonstrated that estimation of renal perfusion based on a single positron emission tomography/computed tomography (PET/CT) scan with Rubidium-82 (Rb) is feasible and found an approximate 5% intra-assay coefficient of variation for both kidneys, indicative of a precise method.This study's aim was to determine the day-to day variation of Rb PET/CT and to test the method's ability to detect increased RBF induced by infusion of amino acids.
METHODS
Seventeen healthy subjects underwent three dynamic Rb PET/CT scans over two examination days comprising: Day A, a single 8-minute dynamic scan and Day B, two scans performed before (baseline) and after RBF stimulation by a 2-hour amino acid-infusion. The order of examination days was determined by randomization. Time activity curves for arterial and renal activity with a 1-tissue compartment model were used for flow estimation; the K kinetic parameter representing renal Rb clearance. Day-to-day variation was calculated based on the difference between the unstimulated K values on Day A and Day B and paired t-testing was performed to compare K values at baseline and after RBF stimulation on Day B.
RESULTS
Day-to-day variation was observed to be 5.5% for the right kidney and 6.0% for the left kidney (n = 15 quality accepted scans). K values determined after amino acid-infusion were significantly higher than pre-infusion values (n = 17, p = 0.001). The mean percentage change in K from baseline was 13.2 ± 12.9% (range - 10.4 to 35.5) for the right kidney; 12.9 ± 13.2% (range - 15.7 to 35.3) for the left kidney.
CONCLUSION
Day-to-day variation is acceptably low. A significant K increase from baseline is detected after application of a known RBF stimulus, indicating that Rb PET/CT scanning can provide a precise method for evaluation of RBF and it is able to determine changes herein.
CLINICAL TRIAL REGISTRATION
EU Clinical Trials Register, 2017-005008-88. Registered 18/01/2018.
Topics: Humans; Amino Acids; Healthy Volunteers; Kidney; Perfusion; Positron Emission Tomography Computed Tomography; Reproducibility of Results
PubMed: 36443713
DOI: 10.1186/s12882-022-02962-w -
Clinics (Sao Paulo, Brazil) 2023Clinical reports associate kidneys from female donors with worse prognostic in male recipients. Brain Death (BD) produces immunological and hemodynamic disorders that...
BACKGROUND
Clinical reports associate kidneys from female donors with worse prognostic in male recipients. Brain Death (BD) produces immunological and hemodynamic disorders that affect organ viability. Following BD, female rats are associated with increased renal inflammation interrelated with female sex hormone reduction. Here, the aim was to investigate the effects of sex on BD-induced Acute Kidney Injury (AKI) using an Isolated Perfused rat Kidney (IPK) model.
METHODS
Wistar rats, females, and males (8 weeks old), were maintained for 4h after BD. A left nephrectomy was performed and the kidney was preserved in a cold saline solution (30 min). IPK was performed under normothermic temperature (37°C) for 90 min using WME as perfusion solution. AKI was assessed by morphological analyses, staining of complement system components and inflammatory cell markers, perfusion flow, and creatinine clearance.
RESULTS
BD-male kidneys had decreased perfusion flow on IPK, a phenomenon that was not observed in the kidneys of BD-females (p < 0.0001). BD-male kidneys presented greater proximal (p = 0.0311) and distal tubule (p = 0.0029) necrosis. However, BD-female kidneys presented higher expression of eNOS (p = 0.0060) and greater upregulation of inflammatory mediators, iNOS (p = 0.0051), and Caspase-3 (p = 0.0099). In addition, both sexes had increased complement system formation (C5b-9) (p=0.0005), glomerular edema (p = 0.0003), and nNOS (p = 0.0051).
CONCLUSION
The present data revealed an important sex difference in renal perfusion in the IPK model, evidenced by a pronounced reduction in perfusate flow and low eNOS expression in the BD-male group. Nonetheless, the upregulation of genes related to the proinflammatory cascade suggests a progressive inflammatory process in BD-female kidneys.
Topics: Rats; Female; Male; Animals; Brain Death; Rats, Wistar; Kidney; Kidney Transplantation; Acute Kidney Injury; Perfusion
PubMed: 37257364
DOI: 10.1016/j.clinsp.2023.100222 -
BMC Nephrology Jul 2020Men have larger kidneys than women, but it is unclear whether gender remains an independent predictor of kidney size (expressed as weight or length) after correction for...
BACKGROUND
Men have larger kidneys than women, but it is unclear whether gender remains an independent predictor of kidney size (expressed as weight or length) after correction for body size. We analysed autopsy data to assess whether relative renal length and weight (e.g. corrected for body weight, height or body surface area (BSA)) are also larger in men. Assuming that kidney size is associated with nephron number, opposite findings could partly explain why women are less prone to the development and progression of chronic kidney disease than men.
METHODS
All forensic autopsies performed between 2009 and 2015 at the local university hospital of Geneva in individuals of European descent aged ≥18 years without a known history of diabetes and/or kidney disease were examined. Individuals with putrefied or severely injured bodies were excluded. Relative renal weight and length were respectively defined as renal weight divided by body weight or BSA and renal length divided by body height or BSA.
RESULTS
A total of 635 autopsies (68.7% men) were included in the analysis. Left kidneys were on average 8 g heavier and 2 mm longer than right kidneys (both: p < 0.05). Absolute renal weight (165 ± 40 vs 122 ± 29 g) and length (12.0 ± 1.3 vs 11.4 ± 1.1 cm) were higher in men. Relative renal weight was also higher in men, but relative renal length was larger in women. In multivariable regression analysis, body height, body weight, the degree of blood congestion or depletion at autopsy and age were determinants of renal weight, whereas arterial hypertension and smoking were not. Percentile curves of renal weight and length according to sex and body height were constructed.
CONCLUSION
Absolute and relative renal weights were both smaller in women. This is in line with recent studies stating that nephron numbers are also lower in women. Relative renal length was longer in women, suggesting that female kidneys have a more elongated shape. In comparison with older autopsy studies, renal weight appears to be stable over time.
Topics: Adult; Aged; Autopsy; Body Height; Body Surface Area; Body Weight; Female; Forensic Pathology; Humans; Kidney; Male; Middle Aged; Organ Size; Reference Values; Sex Characteristics
PubMed: 32689967
DOI: 10.1186/s12882-020-01946-y