Tag Archive | "kidney function"

Partial Versus Complete Removal of Kidney in Cancer Treatment is Better for Bone Health

Recent research at the University of California, San Diego School of Medicine has shed new light on how surgery impacts both chronic kidney disease and bone health, especially in women.  These findings emphasize the importance of pursuing kidney-sparing surgery in an effort to preserve kidney function and to reduce the risk of bone fractures later in life.  The study was published in last month’s edition of Urology.

Ithaar Derwesh, MD, senior author and urologic oncologist at UC San Diego Moores Cancer Center that when weighing risks and benefits of partial versus radical nephrectomy, doctors and patients should take into account the impact on a patient’s bone health.  The study emphasizes that preserving the kidney helps to prevent chronic kidney disease and significantly reduces bone fractures and risk of developing osteoporosis.

The complete removal of a kidney has been found to be a significant factor for chronic kidney disease, which carries increased risk for metabolic complications, cardiovascular disease and death.  In the case of partial nephrectomy, functional kidney tissue and healthy cells are preserved and can help prevent or reduce the risk of development of chemical imbalances such as metabolic acidosis, which could later lead to kidney dysfunction, muscle wasting and osteoporosis.  Osteoporosis is a direct cause of bone loss and fractures.

Christopher Kane, MD, Professor of Surgery, C. Lowell and JoEllen Parsons Endowed Chair in Urology and Chief of the Division of Urology, emphasized that women undergoing kidney surgery should find out whether partial kidney removal is an option as it may help prevent bone brittleness.  Kane says that urologists have too often done radical nephrectomies for patients who were candidates for partial nephrectomy. Although partial nephrectomy is a more complex surgery, it can offer better later quality of life.

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Dipstick Urine Test Can Help Identify Risk for Kidney Function Decline

According to a recent study published in the Journal of the American Society Nephrology, a simple and inexpensive urine test routinely done in family doctors’ offices may be the key to identifying individuals who are silently undergoing rapid kidney function decline.

William Clark, MD, of the University of Western Ontario and London Health Sciences Centre in London, Canada and his colleagues analyzed whether simple and routine screening tests for urine protein could be used to identify people at highest risk for rapid kidney function decline because these patients would benefit the most from serial kidney function monitoring and early treatments to prevent kidney failure.

The study analyzed 2,574 participants in a community-based clinic for an average of seven years.  The research team found that a positive dipstick urine test (with a protein concentration of at least 1g/L) was a strong predictor of rapid kidney function decline.  In total, 2.5 percent of participants in the study had a urinary protein concentration of at least 1g/L at the beginning of the study.  If all of the participants were followed with serial monitoring of kidney function, one case of rapid kidney function decline would be identified for every 2.6 patients followed.

This test correctly identified whether individuals had rapid kidney function decline in 90.8 percent of participants, mislabeled 1.5 percent as having the condition, and missed 7.7 percent who were later identified as having the condition.  Among participants with certain risk factors including cardiovascular disease, being older than 60 years, diabetes, or hypertension, the chance of identifying rapid kidney function decline from serial kidney function measurements increased from 13 percent to 44 percent after incorporating a positive dipstick test.

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LDL Lowering Not Found To Slow Progression of Renal Disease

David Lewis, MD, of the Clinical Trial Service Unit at the University of Oxford, presented overall and sub-analyses of the renal results of the Study of Heart and Renal Protection (SHARP) at the European Renal Association – European Dialysis and Transplant Association in Prague in June.

The study found that lowering LDL cholesterol can prevent and reverse atherosclerosis, but it does not do the same for the progression of chronic kidney disease (CKD).  Preclinical and clinical results suggested that elevated LDL is associated with the development and progression of kidney disease and that lowering LDL could impede the loss of kidney function.  The SHARP trial investigators tested whether such an intervention could slow the progression of renal disease in patients with CKD.

The research team randomly assigned CKD patients aged 40 years and older to receive SIM/EZE, SIM 20 mg, or a placebo for one year.  SIM alone was used as a comparison to assess the safety of adding EZE to SIM.  At one year, patients on SIM were randomized to either the SIM/EZE cohort (4,650 patients) or to the placebo (4,620 patients).  The patients were followed for a median of 4.9 years and a minimum of four years.  SIM/EZE was correlated with a mean LDL reduction of 33m/dL at 2.5 years compared with the placebo arm.

In the entire sample of 9,270 patients with a mean age of 63 years, two-thirds were not on dialysis at the beginning of the trial, and the rest were.  Study participants could not have had a myocardial infarction or coronary revascularization.

The researchers observed no significant effect from the administration of the LDL lowering therapy.

Session moderator Johannes Mann, MD, Director of the Department of Nephrology at Munich General Hospitals emphasized the good news.  He stressed that even if the presence of kidney disease is the only cardiovascular risk factor present, doctors should use LDL lowering independent of patients’ baseline LDL cholesterol because many patients who are not receiving this treatment should be receiving it.

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Diet Drugs Alli and Xenical Linked To Kidney Injury

A new study based on 953 new users of orlistat reported a link in increase kidney injuries. Orlistat is the active ingredient in the diet drugs Alli and Xenical and works by inhibiting the absorption of fat in the gut.

It was found that 0.5 percent of new orlistat users were hospitalized for kidney problems in the year before starting on the drug and over the next year that number jumped to 2 percent.  Dr. Matthew Weir, who worked on the study, said a few earlier case reports had found kidney problems in people on Xenical, but that it wasn’t listed among the drug’s side effects. “This study should be interpreted cautiously as it is observational and cannot prove causality” he added.

Last year U.S. health officials warned about liver damage in patients on Xenical and Alli.

This is another blow to diet drugs yet Alli’s global sales totaled about $317 million in 2009 and Xenical’s worldwide sales hit about $345 million in the same year.

“I think the take-home message should be that patients on orlistat should have their kidney function carefully monitored,” Weir said, “but since orlistat is available (over-the-counter) in the US, this may be easier said than done.”

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