A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in Internal Medicine. Johannesburg, 2013 / This study reports a review of biopsy-confirmed renal pathology from Soweto Gauteng. A retrospective analysis was conducted of 1848 adult native renal biopsy reports from Chris Hani Baragwanath Academic Hospital from 1 January 1982 to 31 December 2011. The mean age of all patients biopsied was 33.5 ± 12.6 years and the majority of patients (96.4%) were black. The most frequent histological findings were secondary glomerular diseases (SGNs) (49.3%) and primary glomerular diseases (PGNs) (39.7%). SGNs increased, while PGNs decreased over time (p<0.001). The main contributors to SGN were lupus nephritis (31.0%) and HIV associated nephropathy (HIVAN) (13.3%) while for PGN it was focal segmental glomerulosclerosis (FSGS) (29.6%). HIV positive biopsies constituted 19.7% of all biopsies with a dominant diagnosis of HIVAN (32.7%). Changing patterns of renal disease are evident in the data. The increased SGNs likely reflect the influence of renal pathology secondary to HIV and lupus nephritis.

Tin Sik Cheng. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1990. / Bibliography: leaves 83-86. / Acknowledgement --- p.i / Abstract --- p.ii / Chapter Chapter 1 --- Introduction --- p.1 / Chapter Chapter 2 --- Methodology --- p.13 / Chapter Chapter 3 --- Determination of the purity of inulin --- p.19 / Chapter Chapter 4 --- Determination of the optimal lysine concentration --- p.25 / Chapter Chapter 5 --- Protective role of lysine --- p.40 / Chapter Chapter 6 --- An enzyme study --- p.52 / Chapter Chapter 7 --- A plasma protein study --- p.71 / Chapter Chapter 8 --- Epilogue --- p.79 / References --- p.83

Thesis (M.D.)—Boston University

Thesis (M.D.)--Boston University

Thesis (Ph.D.)--Aberdeen University, 2009. / Title from web page (viewed on Oct. 5, 2009). Includes bibliographical references.

Background Chronic Kidney Disease (CKD) can be described as the loss of the kidney function over time. Symptoms usually develop slowly, and it may not appear in early stages. Lab tests can confirm a CKD diagnosis. The approximate number of incidents per year is more than 200,000 cases, and approximately 30 million people are living with CKD today in the United States. This long-standing disease ultimately leads to renal failure at the end. At this present time, there are no known cures for CKD, and the only treatment available is dialysis. Objectives The purpose of this study is to determine the association between CKD and further with hemodialysis (HD) and medical condition such as cardiac complications, cardiogenic shock, hemorrhage, anemia, vascular complication, postop respiratory failure, post op infarct hemorrhage, acute renal failure, new temporary pacemaker, new permanent pacemaker, pericardial complications, and death. Study design The study employed secondary data in a cross-sectional design. Methods A sample of 106,969 was drawn from the population. The outcome variables were a diagnosis of CKD and/or CKD with HD. The predictor variables were cardiac complications, cardiogenic shock, hemorrhage, anemia, vascular complication, postop respiratory failure, post op infarct hemorrhage, acute renal failure, new temporary pacemaker, new permanent pacemaker, pericardial complications and death. Logistic regression was conducted to analyze the relationship between outcome variable and each independent variable. Variables with a p-value Results Analysis shows that subjects with cardiac complications were 17% less likely to have CKD as compared to those who did not have cardiac complications (OR: 0.83, 95% CI: 0.78-0.88). CKD patients who had cardiac complications were 18% more likely to have HD than the subjects who did not have cardiac complications (OR: 1.18, 95% CI: 1.01-1.39). Patients with cardiogenic shock were 86% more likely to have CKD than the subjects who did not have cardiogenic shock (OR: 1.86, 95% CI: 1.82-1.91). CKD patients who had cardiogenic shock were also 18% more likely to have HD than the subjects who did not have cardiogenic shock (OR: 1.18, 95% CI: 1.11-1.25). We have similar results if a patient had other conditions. Conclusion Chronic kidney disease with hemodialysis is significantly associated by the other medical conditions such as cardiac complications cardiogenic shock, hemorrhage, anemia, vascular complication, postop respiratory failure, post op infarct hemorrhage, acute renal failure, new temporary pacemaker, new permanent pacemaker, pericardial complications and death in the United States. Further studies are needed to confirm the results and to understand the prognosis.

Celiac disease, an inflammatory disease of small bowel caused by sensitivity to dietary gluten and related protein, affects approximately 0.5-1% of the population in the Western world. Extra-intestinal symptoms and associated diseases are increasingly recognized including diabetes mellitus type 1, thyroid disease, dermatitis herpetiformis and ataxia. There have also been a number of reports of various types of renal involvement in patients with celiac disease including diabetes nephropathy, IgA nephropathy, membranous nephropathy, membranoproliferative glomerulonephritis, nephrotic syndrome related to malabsorption, oxalate nephropathy, and associations of celiac disease with chronic kidney disease and end-stage kidney disease. This review aims to present the current literature on possible pathologic mechanisms underlying renal disease in patients with celiac disease.

Methods: All patients (5606) with at least one serum creatinine ≥130μmol/L in females and ≥150μmol/L (Index creatinine) in males during a 6 month period in 2003 were grouped according to whether they had Acute Kidney Injury (AKI), Acute on chronic renal failure (ACRF) and chronic kidney disease (CKD). 1903 patients could  not be classified. After using all available creatinine data and identifying markers of kidney damage a further group of patients with CKD were identified. Case records were examined for the presence of co-morbidity, date of death, cause of death and whether they were known to a renal physician. Results: 1225 patients were identified as having CKD out of the 1903 “Unclassified” cohort (65%). The majority of CKD patients were elderly females with Stage 3 CKD. Hypertension and ischaemic heart disease were the two most common co-morbid conditions. Only 12% of CKD patients were referred to a nephrologists. 43% of CKD patients were dead at follow-up mostly from cardiovascular causes (31^st December 2005). The presence of proteinuria was independently associated with death. The age adjusted standardised prevalence of CKD, excluding those on RRT, was 20929 per million adult population. 3.6% went on to start RRT by the end of follow-up. Conclusions: CKD is predominantly a condition of elderly females, associated with considerable morbidity and mortality. However the majority of patients die from cardiovascular disease before progressing to ESRD. Therefore these patients may be appropriately managed in primary care without the need for specialist renal input allowing targeting of the specialist renal resources to the fewer patients who require them.

Dragon (RGMb) is one of the three repulsive guidance molecule (RGM) family members RGMa, RGMb (Dragon) and RGMc (hemojuvelin). RGM family members are glycophosphatidylinositol (GPI)-anchored membrane proteins. The three RGM proteins have been identified as co-receptors that enhance BMP-Smad signaling. Previous studies showed that Dragon protein is expressed in the epithelial cells of kidney tubules including collecting ducts, distal convoluted tubules and thick ascending limbs, and that Dragon enhances BMP4 signaling in tubular epithelial cells. However, the biological roles of Dragon in the renal epithelial cells are yet to be defined. / We now showed that overexpression of Dragon inhibited E-Cadherin expression, but did not affect epithelial-to-mesenchymal transition (EMT) induced by TGF-β1 in mouse inner medullary collecting duct (IMCD3) cells. Dragon also increased cell death induced by hypoxia in association with increased cleaved PARP and cleaved Caspase-3 levels in IMCD3 cells. Dragon did not have any effect on the expression of inflammatory factors in IMCD3 cells. Previous studies suggest that the three RGM members can also function as ligands for the receptor neogenin. Interestingly, our present study demonstrates that the Dragon actions on apoptosis and E-Cadherin expression in IMCD3 cells were mediated by the neogenin receptor but not through the BMP pathway. / Dragon expression in the kidney was upregulated by unilateral ureteral obstruction (UUO) in mice. Compared with wild-type mice, heterozygous Dragon knockout mice exhibited 45-66% reduction in Dragon mRNA expression, decreased epithelial cell apoptosis, increased tubular E-Cadherin expression, and had attenuated tubular injury after UUO. UUO-induced renal fibrosis and inflammation did not change between wild-type mice and heterozygous Dragon knockout mice. Similar results were obtained in the model of ischemia-reperfusion kidney injury. Compared with wild-type mice, heterozygous Dragon knockout mice showed decreased epithelial cell apoptosis. Ischemia-induced renal fibrosis and inflammation did not change between wild-type mice and heterozygous Dragon knockout mice. / Our results suggest that Dragon may impair tubular epithelial integrity and induce epithelial cell apoptosis both in vitro and in vivo. / Dragon (又稱排斥導向分子b) 是排斥導向分子家族中的一員。這個家族包括排斥導向分子a，排斥導向分子b (又稱Dragon) 和排斥導向分子c (又稱血幼素) 三名成員。它們都是一種磷脂酰肌醇(GPI) 錨定蛋白。研究發現，這三種排斥導向分子都可以作為輔助受體來加強骨形成蛋白信號通路。我們之前的研究發現，Dragon在集合管、遠曲小管和髓袢升支粗段的上皮細胞內都有表達，同時Dragon增強腎小管上皮細胞中骨形成蛋白(BMP)4的信號轉導。但是，Dragon在腎小管上皮細胞中的生物學功能尚不清楚。 / 我們的研究結果表明，Dragon過量表達后降低腎內髓集合管上皮細胞中上皮型鈣粘素 (E-Cadherin) 的表達，但是不影響轉化生長因子-β1誘導的上皮細胞向間充質細胞的轉化。在低氧的條件下，Dragon促進腎內髓集合管上皮細胞的死亡并同時增加活化的多聚二磷酸腺苷酸核糖聚合酶（PARP）和半胱天冬酶3 (Caspase-3) 的量。但是Dragon對腎內髓集合管上皮細胞分泌的免疫因子沒有影響。之前的研究表明，neogenin是這三個導向排斥分子的受體。同樣在我們的研究中發現，Dragon是通過neogenin受體而不是骨形成蛋白信號通路來影響腎內髓集合管上皮細胞的死亡和E-Cadherin的表達。 / 單側輸尿管結扎手術后，在受損傷的小鼠腎臟中Dragon的表達升高。與野生型的小鼠相比，雜合型Dragon敲除小鼠中Dragon信使核糖核酸的表達下降了45-66%，腎小管上皮細胞的凋亡減少，腎小管E-Cadherin的表達升高。單側輸尿管結扎手術后野生型和雜合型Dragon敲除小鼠腎臟皆存在纖維化和炎症，但是二者沒有差異。缺血再灌注的小鼠模型實驗中得到相似的結果。與野生型的小鼠相比，雜合子Dragon敲除小鼠中腎小管上皮細胞凋亡的數目減少。同樣缺血再灌注手術后野生型和雜合子Dragon敲除小鼠腎臟都也存在纖維化和炎症，但二者沒有差異。 / 體內和體外實驗结果均表明，在腎臟損傷過程中Dragon可能損害腎小管上皮的完整性并促進腎小管上皮細胞的凋亡。 / Liu, Wenjing. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2014. / Includes bibliographical references (leaves 192-212). / Abstracts also in Chinese. / Title from PDF title page (viewed on 03, October, 2016). / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.

Using grounded theory methodology this study examined the acquisition and exercise of nephrology nursing expertise, seeking to answer the following questions: what constitutes expertise and how it develops in nephrology nursing; and whether expert nephrology nurses practice differently from non-expert nephrology nurses and, if so, how. Sampling consisted of 6 non-expert and 11 expert nurses from a renal unit in New South Wales, and data were obtained from participant observation of the nurses and subsequent interviews. A substantive theory was generated utilising an orchestral metaphor to explain the skills-acquisitive/exercise process. Findings revealed a three stage skills-acquisitive process: non-expert, experienced non-expert and expert. Each stage was typified by four characteristics that altered during the acquisitive process: knowledge, experience, skills and focus. The findings also identified features of the skill-acquisitive/exercise process either not reported or left implicit in previous studies, including the centrality of recognition of expertise; blurring the boundaries to expert practice; and the role of motivation, enjoyment and commitment to the acquisition of / Doctor of Philosophy (PhD)