Background: Aim of this single center cross-sectional study was to investigate oral behavior, dental, periodontal and microbiological findings in patients undergoing hemodialysis (HD) and after kidney transplantation (KT). Methods: Patients undergoing HD for end-stage renal failure and after KT were investigated. Oral health behavior was recorded using a standardized questionnaire, e.g. dental behavior, tooth brushing, oral hygiene aids. Oral investigation included screening of oral mucosa, dental findings (DMF-T) and periodontal situation (Papilla bleeding index [PBI] periodontal probing depth [PPD] and clinical attachment loss [CAL]). Additionally, microbiological analysis of subgingival biofilm samples (PCR) was performed. Statistical analysis: Student’s t-test or Mann–Whitney-U-test, Fisher’s exact test (α = 5 %). Results: A total of 70 patients (HD: n = 35, KT: n = 35) with a mean age of 56.4 ± 11.1 (HD) and 55.8 ± 10.9 (KT) years were included. Lack in use of additional oral hygiene (dental floss, inter-dental brush) was found. KT group presented significantly more gingivial overgrowth (p = 0.01). DMF-T was 19.47 ± 5.84 (HD) and 17.61 ± 5.81 (KT; p = 0. 21). Majority of patients had clinically moderate and severe periodontitis; showing a need for periodontal treatment of 57 % (HD) and 71 % (KT; p = 0.30). Significantly higher prevalence of Parvimonas micra and Capnocytophaga species in the HD group were found (p < 0.01). Conclusion: Periodontal treatment need and lack in oral behavior for both groups indicate the necessity of an improved early treatment and prevention of dental and periodontal disease, e.g. in form of special care programs. Regarding microbiological findings, no major differences between KT and HD patients were found.

No description available.

Empiric antimicrobial therapy often consists of the combination of Gram-positive coverage with vancomycin (VAN) and Gram-negative coverage, specifically an anti-pseudomonal beta-lactam, such as piperacillin-tazobactam (PTZ). Nephrotoxicity is commonly associated with VAN therapy; however, recent reports demonstrate increasing nephrotoxicity rates among patients treated with the combination of VAN and PTZ. This study evaluated the effect of the VAN/PTZ combination on acute kidney injury (AKI), as defined by the RIFLE criteria, compared to VAN and PTZ monotherapies. Overall, 11,650 patients were analyzed, with 1,647 (14.1%) AKI cases occurring. AKI was significantly more frequent in the VAN/PTZ group (21%) compared to either monotherapy group (VAN 8.3%, PTZ 7.8%, p<0.001 for both). Combination therapy was independently associated with higher AKI odds compared to monotherapy with either agent (aOR=2.03; 95% CI 1.74-2.39; aOR=2.31; 95% CI 1.97-2.71, for VAN and PTZ, respectively). Receipt of concomitant nephrotoxic drugs were independently associated with increased AKI rates, as were increased duration of therapy, length of hospital stay, increasing severity of illness, and increasing baseline renal function. VAN combined with PTZ was associated with twice the odds of AKI development compared to either agent as monotherapy. This demonstrates the need for judicious use of combination empiric therapy.

Recent investigations into the permeability of the kidney capillaries have produced conflicting reports. This study was an attempt to better describe the permeability of the kidney capillaries by using narrow-range macromolecular dextran fractions in four molecular sizes: MW 61,400, MW 77,000, MW 118,000, and MW 147,000. Permeability was measured by dextran concentration differences in plasma and kidney lymph. Permeability decreased as the dextran molecular weight increased. Molecular weights 61,400 and 77,000 penetrated into the kidney lymph. Molecular weight 118,000 exhibited greater difficulty in penetrating to the lymph. The largest fraction penetrated into the kidney lymph with greatest difficulty. Plasma expansion by saline infusion increased the permeability of all dextran fractions.

Two swine kidney proteins (PI 4.8 and 5.8) both possessing 9-prostaglandin ketoreductase (9-PGKR) and 15-hydroxyprostaglandin dehydrogenase (15-PGDH) activities were purified to homogeneity. Purification increased specific activities in parallel. Molecular weight, subunit size, amino acid composition, coenzyme and substrate specificity and antigenicity of both proteins were similar. Gel filtration and SDS-polyacrylamide gel electrophoresis molecular weights of 29,500 and 29,000, respectively, suggested a single subunit. Although a variety of prostaglandins served as substrates, the best for 15-PGDH was PGB, while PGA_1-GSH showed the lowest Km for 9-PGKR. Rabbit antibody against the PI 5.8 protein crossreacted with both purified renal enzymes and with extracts from rat spleen, lung, heart, aorta, and liver.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Background: Chronic kidney disease (CKD) affects approximately 20 million Americans and is the cause of significant morbidity and mortality. Anemia, common in CKD, develops early in the disease process. It contributes to increased risk of cardiovascular disease, hospitalization, mortality, and diminishes health-related quality of life. Intravenous iron and Erythropoiesis Stimulating Agents (ESAs) are recommended for anemia management in CKD. The utilization patterns of IV iron and ESA, and their impact on hospital costs and length of stay merits investigation. Objectives: There were five general objectives of this investigation. The rate and extent of utilization of IV iron in anemic CKD patients was quantified across teaching hospitals in the US. Patient characteristics of those receiving IV iron and ESA and ESA alone were evaluated in detail. Predictors of IV iron and ESA use were determined. The impact of IV iron and ESA use was examined separately for total hospital costs and length of stay (LOS) while adjusting for confounding. Methods: This is a retrospective cohort analysis within the University Health System Consortium data warehouse. Eligible patients are those who were admitted to a hospital and received either IV iron and ESA or both at least once during the period of January 1, 2006, and December 31, 2008. Inclusion criteria include age > 18 years old with a primary or secondary diagnosis of CKD. The exposure of interest was IV iron and ESA therapy, and the outcome was the difference in total hospital costs and length of stay between patients only on ESA, and those on ESA and IV iron. A clustered binomial logistic regression using the GEE methodology was used to identify predictors of IV iron utilization. Propensity scores were used to control for confounding. A generalized estimating equations (GEE) model using a gamma distribution and log link was used to determine the adjusted hospital cost and length of stay for the IV iron and ESA and ESA alone therapy groups. Results: During the study period, 82,947 patients met all the inclusion and exclusion criteria. Of the 82,947 CKD patients on ESA therapy, only 8% (n = 6678) patients were on IV iron supplementation. Age, race, primary payer, admission status, severity of illness, dialysis status and physician specialty were identified as strong predictors of IV iron use in CKD patients. According to the multivariate model, the overall mean hospital cost for all 82,947 patients was $31,674. For patients using both IV iron and ESA (n=6678), mean costs were $34,756 compared to $31,404 for ESA users alone (n=76,269) – a difference of $3,352. The overall mean LOS for all patients was 9.75 days. For those using IV iron, the LOS was 10.71 days, and for those only using ESA, the LOS was 9.66 days– a difference of approximately 1 day. Conclusions: This inquiry is the first large multi-center investigation to quantify the impact of IV iron and ESA use on total hospital costs and LOS. Our investigation showed significant reduction in ESA doses with the use of IV iron supplementation, however, the overall prevalence of IV iron usage was low. Intravenous iron users were associated with a higher total hospital cost and longer length of stay than ESA users.

L'insulino-résistance est une caractéristique majeure du syndrome métabolique dont l'incidence ne cesse d'augmenter dans les pays industrialisés parallèlement à l'épidémie d'obésité. La résistance à l'insuline s'accompagne de diverses atteintes au niveau cardiaque, vasculaire et rénal. L'objectif principal était dans un modèle d'insulino-résistance induite par un excès de fructose chez le rat d'évaluer l'influence de la modulation en sodium (en excès ou en restriction) sur les changements métaboliques cardio-rénaux. D'une part, l'influence d'une restriction sodée concomitante à un régime riche en fructose a été évaluée. Nous avons montré que la restriction sodée prévenait les dommages cardio-rénaux. Ces effets bénéfiques ont été associés à une diminution de l'inflammation rénale et du stress oxydant. De plus, une prévention des modifications du tissu adipeux induites par le régime riche en fructose a été également observée. D'autre part l'impact d'une insulino-résistance en présence d'une consommation excessive et précoce (sevrage) en sodium a été évalué. Quand l'insulino-résistance (régime fructose) est initiée secondairement à un régime hypersodé, l'hypertrophie cardiaque associée au régime sodé est diminuée après l'ajout d'une insulino-résistance. Ce résultat paradoxal pourrait représenter une mal-adaptation du muscle cardiaque que confirme l'altération de la fonction systolique. En conclusion ce travail démontre une fois de plus l'impact de la nutrition dans la modulation des atteintes des organes cibles. L'importance d'adopter une nutrition raisonnée par contrôle de l'ingestion de sodium peut permettre de réduire les atteintes des organes cibles observées dans l'insulino-résistance. / Insulin resistance is a major feature of the metabolic syndrome whose incidence is increasing in industrialized countries, in parallel with the obesity epidemic. Insulin resistance is associated with various cardiac, vascular and renal damages. The main objective was to evaluate the influence of sodium modulation (excess or restriction) on cardio-renal changes in a model of insulin resistance induced by fructose in rats. On one hand, the influence of salt restriction concomitant with a high fructose diet was evaluated. We have shown that sodium restriction prevents cardio-renal damages. These beneficial effects were associated with a reduction in renal inflammation and oxidative stress. In addition, a prevention of adipose tissue changes induced by fructose-rich diet was also obeserved. On the other hand impact of insulin resistance in presence of an early (weaning) sodium and excessive consumption of sodium was evaluated. When insulin resistance (fructose diet) was initiated secondary to high salt diet, cardiac hypertrophy associated with sodium diet decreased after the addition of insulin resistance. This paradoxal result could represent a maladaptation of cardiac muscle confirmed the impaired systolic function. In conclusion this work further demonstrates the impact of nutrition in the modulation of target organ damage. Reducing sodium intake may provide an easy way to reduce target organ damage observed in insulino resistance.

L'insuffisance rénale chronique (IRC) et son stade terminal sont associés à diverses complications, parmi lesquelles de nombreuses modifications du milieu intérieur : urémie, anémie, hyperparathyroïdie, rétention urémique… Les taux d'urée plasmatique ont longtemps été utilisés comme critère diagnostique de l'IRC, malgré l'absence de caractéristiques essentielles à un tel marqueur. Ces caractéristiques ont été discutées au regard de l'utilisation historique des déterminations d'urée. La caractérisation des altérations plasmatiques des patients en IRC est essentielle à la compréhension de la maladie et de leur lien avec la morbi-mortalité. Nous avons alors étendu notre champ d'intérêt à l'ensemble des solutés de rétention urémique, et sommes parvenus à identifier 56 nouveaux solutés à partir des études cliniques récemment publiées. L'évaluation diagnostique s'est poursuivie par l'étude des concentrations plasmatiques et urinaires en acides aminés et de leur association avec le stade d'IRC et ses complications, permettant alors la génération d'hypothèses sur l'origine métabolique de ces altérations. D'autre part, la mise en place d'une méta-analyse à montré une réduction du risque de décès chez les patients traités par dérivés de la vitamine D. La correction des comorbidités (hypovitaminose, perturbations du métabolisme phosphocalcique) et d'autres effets néphroprotecteurs expliqueraient ces bénéfices. Enfin, l'évaluation du protéome urinaire et du score CKD273 qui en résulte s'est avérée très intéressante pour l'identification des patients à risque de progresser, ce qui est un enjeu de santé publique. Ces travaux d'analyse bibliographique et de recherche clinique s'intègrent dans une volonté d'amélioration de la caractérisation de l'IRC et de l'évaluation de sa progression dans le but de prévenir ses complications. Ils sont le socle d'un projet plus large d'observation et d'analyse des caractéristiques des patients en IRC et de leur évolution. / Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are associated with various complications, many of which occur within the internal environment: uremia, anemia, hyperparathyroidism, uremic retention… Plasma urea concentrations have long been used as a diagnostic criterion of CKD, despite the absence of some key characteristics. We discussed these features with regards to the historical uses of urea determinations. It is essential to characterize the plasma changes which occur in CKD to understand the disease and the relationship with comorbidities. We expanded our focus to all of uremic retention solutes, and identified 56 new solutes from recently published clinical studies. The study of plasma and urinary concentrations of amino acids and their association with CKD stage and complications further extended the study of CKD diagnosis, and allowed to generate hypotheses on the metabolic origin of these alterations. On the other hand, by meta-analysis, we showed a reduced risk of death in patients treated with vitamin D derivatives. Correcting comorbidities (hypovitaminosis, disturbances of bone and mineral metabolism) and other renoprotective effects may explain these benefits. Finally, the determination of the urinary proteome and the resulting CKD273 score was proved to be very useful for identifying patients at risk of progression, which is a public health issue. This work based on clinical research and literature analyses is part of an effort to improve the characterization of CKD and the evaluation of progression in order to avoid complications. It is the basis for a wider observational project: analyzing the characteristics of CKD patients and their changes over time.

No description available.