January 19, 2009, 6:10 AM CT

Inner secrets of the bleeding heart

Images that for the first time show bleeding inside the heart after people have suffered a heart attack have been captured by scientists, in a newly released study published recently in the journal Radiology

The research shows that the amount of bleeding can indicate how damaged a person's heart is after a heart attack. The researchers, from the MRC Clinical Sciences Centre at Imperial College London, hope that this kind of imaging will be used alongside other tests to create a fuller picture of a patient's condition and their chances of recovery.

The research was funded by the Medical Research Council, the British Heart Foundation and the Department of Health, UK.

People suffer heart attacks when an artery that feeds blood to the heart becomes blocked, stopping the heart's blood supply and depriving the heart muscle of oxygen. Currently, most people treated for a heart attack are fitted with a metal tube called a stent to keep the blocked artery clear.

Recent research has shown that some people experience bleeding inside the heart muscle once blood starts to pump into it again. However, the significance of this bleeding is currently not understood.

For the new small study, the scientists captured images of bleeding inside the heart in 15 patients from Imperial College Healthcare NHS Trust who had recently suffered a heart attack, using Magnetic Resonance Imaging (MRI). Analysis of the MRI scans revealed that the amount of bleeding correlated with how much damage the heart muscle had sustained......... Posted by: Mark      Read more         Source

November 11, 2008, 9:17 PM CT

Preventing anemia is important to kidney disease

Maintaining sufficient red blood cell levels is important to the physical and mental health of patients with chronic kidney disease (CKD), as per a research studyappearing in the January 2009 issue of the Clinical Journal of the American Society Nephrology (CJASN). The findings indicate that preventing anemia in kidney disease patients should be an integral part of their care.

Erythropoiesis-stimulating agentsmedications that elevate red blood cell levels (hemoglobin)have been a topic of controversy lately, and their use in patients with chronic kidney disease has come into question. Recent studies have shown an increased risk of death, blood clots, strokes, and heart attacks in patients with chronic kidney failure when erythropoiesis-stimulating agents are given at higher than recommended doses. (Current recommendations indicate that therapy should not elevate hemoglobin levels over 12 gm/dl). Other studies have observed a link between the recommended doses of these drugs and an increased risk of death in patients with cancer and an increased risk of blood clots in patients following orthopedic surgery. In addition, the US Food and Drug Administration stated that the benefits of erythropoiesis-stimulating agents have not been well documented, especially as they relate to quality of life. These suggestions are disturbing to nephrologists, who think that these drugs have significantly helped their CKD patients......... Posted by: Mark      Read more         Source

September 14, 2008, 10:30 PM CT

Depressed dialysis patients more likely to be hospitalized

Dialysis patients diagnosed with depression are nearly twice as likely to be hospitalized or die within a year than those who are not depressed, a.

UT Southwestern Medical Center researcher has found.

In the study, available online and in the Sept. 15 issue of Kidney International, scientists monitored 98 dialysis patients for up to 14 months. More than a quarter of dialysis patients received a psychiatric diagnosis of some form of depression based on a Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM IV).

This is the first reported link between adverse clinical outcomes in dialysis patients and depression made through a formal psychiatric interview based on the DSM-IV standards. More than 80 percent of the depressed patients died or were hospitalized, compared with 43 percent of non-depressed patients. Cardiovascular events, which previously have been associated with depression, led to 20 percent of the hospitalizations.

"Twenty percent of patients who start dialysis will die by the end of the first year," said Dr. Susan Hedayati, assistant professor of internal medicine and the study's lead author. "What we don't know yet is, if their depression is treated, could it extend dialysis patients' survival and improve their quality of life"......... Posted by: JoAnn      Read more         Source

July 23, 2008, 4:51 PM CT

'Statins' linked to improved survival

For patients receiving kidney transplants, therapy with cholesterol-lowering "statin" drugs may lead to longer survival, reports a study in the November 2008 Journal of the American Society of Nephrology (JASN).

"Statin treatment is well established for the primary and secondary prevention of cardiovascular disease in the general population, but its effectiveness in patients with kidney disease is unclear," comments Dr. Rainer Oberbauer of the Medical University of Vienna, one of the study authors. "We showed that statin treatment was indeed linked to a lower risk of death in renal transplant recipients."

The study included data on 2,041 patients receiving their first kidney transplant between 1990 and 2003. At the time of transplantation, about 15 percent of the patients were taking statin drugs to reduce their cholesterol levels. Patient survival and survival of the transplanted kidney were compared for patients who were and were not taking statins.

Overall, survival was somewhat better for patients on statin therapy. At 12 years' follow-up, 73 percent of statin-treated patients were alive, in comparison to 64 percent of patients not taking statins.

An important part of the study was the use of sophisticated statistical analyses to adjust for potentially confounding variablesincluding the fact that patients taking statins had more cardiovascular risk factors and pre-existing cardiovascular disease. The results showed a significantly lower risk of death in patients taking statins36 percent lower than in nonusers......... Posted by: Mark      Read more         Source

May 22, 2008, 10:01 PM CT

More Intensive Dialysis Does Not Improve Outcomes

No significant difference in death rates or other outcomes was found between a group of patients with acute kidney injury that received intensive dialysis and another group that received a more standard regimen of dialysis, as per a joint Department of Veterans Affairs (VA) and National Institutes of Health (NIH) study reported in the recent issue of the New England Journal (NEJM). Acute kidney injury, also called acute renal failure, is a common complication in hospitalized patients that is linked to very high mortality rates. In-hospital mortality rates of critically-ill patients typically range from 50 percent to 80 percent.

Several previous single-center studies in patients with acute kidney injury had suggested improved survival with more intensive dialysis, which is significantly more costly to administer. "We now have definitive evidence that intensive therapy of acute kidney injury is no more beneficial in improving therapy outcomes than the usual level of care," said NIH Director Elias A. Zerhouni, M.D. "As a result, the findings of this well-designed study may help prevent unnecessary medical expenditures."

Within 60 days after starting dialysis, 302 patients (53.6 percent) in the intensive therapy group died in comparison to 289 patients (51.5 percent) in the less-intensive therapy group. Also, the study reports no significant differences between the two groups in recovery of kidney function, the rate of failure of organs other than kidneys, or the number of patients able to return to their previous living situations......... Posted by: Mark      Read more         Source

November 28, 2007, 9:57 PM CT

Live kidney donors report high satisfaction rates

Live kidney donors suffer minimal health problems and 90 per cent would strongly encourage other people to a become a donor if a partner or family member needed a transplant, as per a research studyof more than 300 people reported in the recent issue of the UK-based urology journal BJU International.

Scientists from Egypt, where live donations are currently the only legal option, carried out detailed evaluations of 339 patients who attended follow-up clinics between January 2002 and January 2007.

Based at a centre which performs about 100 live donor transplants a year, they included patients who had donated kidneys between 1976 and the end of 2001 in their research.

Living donors remain the main option in developing countries where donations from dead donors have yet to establish roots, because of the lack of infrastructure or the implementation of legal criteria for brain death explains lead author Dr Amgad E El-Agroudy from the Urology and Nephrology Center at Mansoura University.

Even in developing countries, the increasing demand for kidneys has resulted in a rapid increase in the number of living donors being used. This had led to concerns about the risk involved in the procedure and its long-term consequences.

All of the people who participated in the study underwent an extensive physical and psychosocial assessment, which included a full range of laboratory tests and detailed medical history. Any medical problems were then compared with health tables for the general population......... Posted by: Mark      Read more         Source

September 12, 2007, 8:01 PM CT

Clinical Trials Present Better Alternatives for Dialysis Patients

But an unhealthy kidney costs more-about $16 billion more, as per Prabir Roy-Chaudhury, MD, PhD, associate professor in the division of nephrology and high blood pressure at the University of Cincinnati (UC).

"It costs about $17 billion a year to care for patients with end-stage kidney disease," he said.

There are currently over 320,000 people undergoing hemodialysis in the United States, a process that costs taxpayers a minimum of $60,000 per patient annually,.

Hemodialysis is a technique in which a machine filters wastes out of a patient's blood once the kidney fails.

"In order to perform successful dialysis, it's critical to have a functioning vascular access," Roy-Chaudhury said.

There are two main types of permanent dialysis access: an arteriovenous fistula, which connects the artery and the vein directly, and an arteriovenous graft, which connects the artery and the vein using a plastic tube.

Unfortunately, these connections may only last between six and 12 months due to stenosis, or narrowing of the veins.

As a result, hemodialysis patients often have repeated hospital admissions and surgeries in order to keep their dialysis access open.

In fact, problems linked to vascular access are probably the biggest factors that reduce the quality of life for hemodialysis patients, Roy-Chaudhury said......... Posted by: Mark      Read more         Source

August 24, 2007, 5:10 AM CT

Single-incision belly-button surgery to remove kidney

Surgeons specializing in laparoscopic procedures at UT Southwestern Medical Center have successfully removed a patients kidney by performing a unique nephrectomy entirely through the belly button.

Dr. Jeffrey Cadeddu, associate professor of urology and radiology, performed the single keyhole access surgery, the first of its kind involving a kidney. The entire procedure was completed with only one incision and will leave the patient with a barely noticeable scar tucked in the umbilicus, or navel.

We are proud of this novel surgical technique, said Dr. Cadeddu, who leads the Clinical Center for Minimally Invasive Treatment of Urologic Cancer. Laparoscopic surgery already gives patients smaller incisions, less pain and a faster recovery. This transumbilical technique is a further extension of laparoscopic surgery, which essentially removes scarring from the patients skin.

Dr. Claus Roehrborn, chairman of urology at UT Southwestern, said, Single-access surgery is the next major advance in making surgery even less invasive. For Dr. Cadeddu to be the first to perform such a surgery and remove the intact organ in this manner is a testament to the tremendous advances in clinical medicine that are being made at UT Southwestern and in our department. Dr. Roehrborn is director of the Sarah M. and Charles E. Seay Center for Pediatric Urology......... Posted by: Mark      Read more         Source

August 3, 2007, 9:59 PM CT

Radiofrequency ablation for kidney tumors

A relatively new, minimally invasive therapy was 93 percent successful in eradicating cancerous kidney tumors, as per a recent study conducted by scientists from Wake Forest University Baptist Medical Center in Winston-Salem, NC.

I have performed a number of radiofrequency ablations of renal tumors and the results looked promising, said Ronald J. Zagoria, MD, lead author of the study. I wanted to scientifically review the data to better assess the results and look for patterns that might predict success or complications, he said.

The study consisted of 104 patients with a total of 125 tumors ranging from 0.6 cm to 8.8 cm. In all patients, a biopsy confirmed the presence of renal cell carcinoma (RCC), the most common type of kidney cancer. Of the 125 tumors, 95 were smaller than 3.7 cm and were completely eradicated in one therapy. Fourteen larger tumors were also eradicated after one therapy. Of the 16 remaining larger tumors, seven were eradicated after a second therapy.

Patients who are not good operative candidates, commonly due to co-existing illnesses, and those with multiple renal tumors, now have an excellent option for curing their tumors, said Dr. Zagoria. Surgery should be the first option, since the long-term results of this procedure have not been substantiated, he said......... Posted by: Janet      Read more         Source

July 8, 2007, 10:09 PM CT

A gene that protects from kidney disease

Scientists from the European Molecular Biology Laboratory (EMBL) and the University of Michigan have discovered a gene that protects us against a serious kidney disease. In the current online issue of Nature Genetics they report that mutations in the gene cause nephronopthisis (NPHP) in humans and mice. NPHP is a disease marked by kidney degeneration during childhood that leads to kidney failure requiring organ transplantation. The insights might help develop effective, noninvasive therapies.

The kidneys are the organs that help our body dispose of potentially harmful waste. Diseases that affect this fundamental function are very serious but so far only poorly understood. NPHP is such a disease; it causes the kidneys to degenerate and shrink starting early on in childhood often leading to renal failure before the age of 30. So far, kidney transplantation in early age has been the only way to save patients suffering from NPHP. With a new mouse model Mathias Treier and his group at EMBL have shed new light on the molecular mechanisms underlying NPHP opening up novel ways to treat the disease.

Our mice show striking similarities with NPHP patients, says Mathias Treier, group leader at EMBL. Very early on in their lives their kidney cells start to die and the mice develop all the characteristic disease symptoms. It is the first time that a mouse model reveals increased cell death as the mechanism underpinning kidney degeneration in NPHP. The genetic cause is a mutation in a gene called GLIS2......... Posted by: Mark      Read more         Source

January 10, 2007, 8:25 PM CT

pivotal Nexavar kidney cancer study published in NEJM

Bayer Pharmaceuticals Corporation and Onyx Pharmaceuticals, Inc. today announced that the New England Journal of Medicine has published their pivotal Phase III trial demonstrating that Nexavar (sorafenib) tablets doubled median progression-free survival (PFS) in patients with advanced renal cell carcinoma (RCC), or kidney cancer. The data, as assessed by independent radiologic review, are from the Treatment Approaches in Renal Cancer Global Evaluation Trial (TARGET) – the largest randomized controlled trial ever conducted in advanced RCC.

"Historically, patients with kidney cancer have had limited treatment options and there has been a particularly critical need for new therapies to help patients with advanced disease," said co-principal investigator Ronald Bukowski, M.D., Director of the Experimental Therapeutics Program of The Cleveland Clinic Taussig Cancer Center in Cleveland, OH. "This landmark study demonstrated the efficacy, tolerability and clinical benefit of Nexavar, which has rapidly become a valuable weapon against this devastating disease."

Based on these data, Nexavar was granted U.S. Food and Drug Administration (FDA) approval for the treatment of patients with advanced RCC, or kidney cancer, on December 20, 2005. Since then, Nexavar has been approved in nearly 50 countries. ........

Posted by: Mark      Read more         Source

December 20, 2006, 4:18 AM CT

Link Between Nanoparticles And Kidney Stones

Scientists at Mayo Clinic have successfully isolated nanoparticles from human kidney stones in cell cultures and have isolated proteins, RNA and DNA that appear to be linked to nanoparticles. The findings, which appear in the recent issue of the Journal of Investigative Medicine, are significant because it is one step closer in solving the mystery of whether nanoparticles are viable living forms that can lead to disease -- in this case, kidney stones.

Kidney stones are linked to pathologic calcification, the process in which organs and blood vessels become clogged with calcium deposits that can damage major organs like the heart and kidneys. What causes calcium deposits to build up is not entirely known. Medical researchers at Mayo Clinic are studying calcification at the molecular level in an effort to determine how this phenomenon occurs.

There is a growing body of scientific evidence that links calcification to the presence of nanosized particles, particles so small that some researchers question whether a nanoparticle can live and if so, play a viable role in the development of kidney stones.

The presence of proteins, RNA and DNA does not prove that nanoparticles are viable living forms because a genetic signature has not been identified, says the study's author John Lieske, M.D., a nephrologist with Mayo Clinic. A genetic signature would prove that nanoparticles are indeed living forms that replicate and can cause disease.........

Posted by: Mark      Permalink         Source

December 9, 2006, 5:45 PM CT

Sutent, One Of The New 'Targeted' Cancer Drugs

The new "smart" drugs are a really exciting element of cancer medicine. One of the new molecularly-targeted cancer drugs is Sutent. It is a "multi-targeted kinase inhibitor." A drug that inhibits several proteins involved in triggering replication in cancer cells. Basically, inhibits various kinases, a type of enzyme that transfers phosphate groups from high-energy donor molecules to specific target molecules.

Sutent (sunitinib) is an inhibitor of multiple protein kinases, platelet-derived growth factor (PDGFR), vascular endothelial growth factor receptors (VEGFR), stem cell factor receptor (KIT), FMS-like tyrosine kinase (Flt3), colony stimulating factor (CSF-1R), and the neurotrophic factor receptor (RET). Because these proteins are involved in both tumor proliferation and angiogenesis, Sutent has both anti-tumor as well as anti-angiogenic properties. In addition, because Sutent inhibits multiple kinases, it possesses activity against multiple types of tumors.

Sutent can be used as a second-line drug for tumors that are non-responsive to Gleevec. The proto-oncogene KIT, a tyrosine kinase that is inhibited by Gleevec, is overexpressed in a majority of GISTs. Some patients have suffered relapses due to acquired point mutations in KIT, which prevents Gleevec from binding to the protein. Similar mutations have been characterized in EGFR from Iressa-resistant lung cancer patients.........

Posted by: Gregory D. Pawelski      Permalink         Source

November 15, 2006, 5:01 AM CT

Obesity An Advantage In Hemodialysis Patients

Despite significant improvements in dialysis therapys, currently over 20% of the 350,000 maintenance hemodialysis (MHD) patients in the United States die each year. A study published in Hemodialysis International finds that this high mortality rate may be attributed to malnutrition.

MHD patients experience what has been termed the "obesity paradox," wherein obesity is linked to increased chance of survival. "A larger body fat mass as seen in obesity probably represents protective reserves that may mitigate the adverse effects of malnutrition in patients," as per Kamyar Kalantar-Zadeh M.D., author of the study.

MHD patients tend to have a high degree of protein-energy malnutrition and inflammation. The combination of these two conditions, termed Kidney Disease Wasting (KDW), leads to increased risk of death. On the other hand, it has been shown that an increase in protein intake yields the greatest survival in patients.

The study suggests that improved diet as well as appetite-stimulating agents may be a way to improve nutrition and, consequently, outcome in MHD patients. Understanding the factors that lead to KDW will be the key to improving survival in MHD patients, as well as in the 20 to 40 million Americans who exhibit similar risk-factor paradoxes such as those with chronic heart failure, AIDS, rheumatoid arthritis and malignancy.........

Posted by: Mark      Permalink         Source

November 7, 2006, 7:08 PM CT

Enzyme For Treatment Of Diabetic Kidney Disease

Northwestern University Feinberg School of Medicine scientists have observed that an enzyme called ACE2 may hold the potential to treat diabetic kidney disease, the most common form of kidney disease.

In the laboratory, scientists led by Daniel Batlle, professor of medicine in the Feinberg School, chief of the nephrology/high blood pressure division and staff nephrologist at Northwestern Memorial Hospital, have found low levels of the ACE2 enzyme in the glomeruli of the kidneys of diabetic mice. When ACE2 was further decreased with an inhibitor drug, kidney disease worsened. Studies are now needed using compounds that increase the level of ACE2 in the kidneys of diabetic mice to see if it reverses or prevents kidney disease from developing, Batlle said.

The experiments appear in a report by Ye et. al in the recent issue of the Journal of the American Society of Nephrology.

Diabetes, which affects 230 million people worldwide and 21 million in the United States, is the leading cause of kidney failure. About one-third of patients with diabetes will go on to develop kidney disease. In diabetes, the small blood vessels in the kidneys are injured and the kidneys cannot clean the blood properly. In 2002, a total of 153,000 people in the U.S. with kidney failure due to diabetes were living on chronic dialysis or with a kidney transplant.........

Posted by: JoAnn      Permalink         Source

November 7, 2006, 4:49 AM CT

More Hemodialysis May Improve Survival

A study recently published in Hemodialysis International observed that more frequent hemodialysis therapys (five or more weekly) can significantly increase the survival rate of patients suffering from irreversible kidney failure. Typical therapy in the U.S. generally involves three sessions weekly.

The study examines the mortality rate of 117 U.S. patients. Those receiving five or more therapys per week were shown to have a 61% better chance of survival when in comparison to patients receiving conventional therapy.

"More frequent hemodialysis has been shown to improve patient well-being, reduce symptoms during and between therapys and have beneficial effects on clinical outcomes," as per Christopher R. Blagg M.D., lead researcher of the study.

U.S. hemodialysis patients continue to have a high annual mortality rate, despite a number of improvements in dialysis and overall medical care. Increasing the frequency of dialysis may be an effective means of improving patient survival.........

Posted by: Mark      Permalink         Source