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Sunday, September 19, 2010

Relationship between Hypertension and Kidney Failure: High Blood Pressure and Kidney Disease

High blood pressure is a major cause of kidney disease and kidney failure (end-stage renal disease). Hypertension can cause damage to the blood vessels and filters in the kidney, making removal of waste from the body difficult

Image Source: intelihealth.com

Renal failure (kidney failure) is caused primarily by chronic high blood pressure (hypertension) over many years. Hypertension is the second major cause, after diabetes, of end stage renal disease (ESRD) and is responsible for 25–30% of all reported cases. In addition, many people with diabetes also have hypertension, thus high blood pressure plays an even larger role in kidney failure.

About 398,000 people were diagnosed with end-stage renal disease in 1998. Of these, about 83,000 had hypertension and about 133,000 had diabetes. That same year, approximately 63,000 people with ESRD passed away. Most people with ESRD have had symptoms for a long time and may have had kidney disease (nephropathy) for as many as 20 years or more prior to experiencing kidney failure.

Genetic profile
It is believed that most cases of hypertension leading to kidney failure have a genetic element. Finding a genetic link is complicated by the fact that nearly half of all people with renal failure have three or more serious disorders, such as diabetes. Animal studies have been done to find genetic linkages to hypertension and kidney failure, but genetic studies on humans are in their infancy. A recent breakthrough came in a study of African American subjects with hypertensive end-stage renal disease. Researchers found a significant association between severe hypertension and mutations on the HSD11B2 gene. This is a gene that plays a role in sodium retention and related factors. Their data suggested that the 16q22.1 chromosome region was the location of the mutation.

In another study, researchers studied an Israeli family of Iraqi-Jewish origin whose members suffered from hypertension and renal failure. The researchers found a genetic locus at 1q21 that was autosomal dominant. They also hypothesized that the gene encoding atrial natriutetic peptide receptor-1 (NPR1) was the disease gene that led to the hypertension/renal failure.

Other families with high rates of hypertension have also been studied. For example, researchers observed a family of Old Order Amish in Lancaster, Pennsylvania and found a genetic link for hypertension to chromosome 2q31-34. The subjects were not experiencing kidney failure, thus, further study would be needed to determine if the identified genetic locus also coded for ESRD.

What Are the Symptoms of Kidney Disease?
The symptoms of kidney disease include:

  • High blood pressure.
  • Decrease in amount of urine or difficulty urinating.
  • Edema (fluid retention), especially in the lower legs.
  • A need to urinate more often, especially at night.
How Is Kidney Disease Diagnosed?
As with high blood pressure, you may not realize that you have kidney disease. Certain laboratory tests can indicate whether your kidneys are eliminating waste products properly. These tests include serum creatinine and blood urea nitrogen (BUN); elevated levels of either can indicate kidney damage. Proteinuria, an excess of protein in the urine, is also a sign of kidney disease.


Sunday, September 5, 2010

Patients Are Injured Due to Missed or Delayed Diagnosis Analysis Shows

Studies show that diagnostic errors cause twice as many adverse events as medication errors, but the subject has received little attention; Pennsylvania Patient Safety Authority reviews 100 events related to diagnostic error

HARRISBURG, Pa., Sept. 1 /PRNewswire-USNewswire/ -- Errors related to missed or delayed diagnosis are frequently a cause of patient injury and therefore an underlying cause of patient safety related events. Autopsy analysis spanning several decades show error rates at four to 50 percent, according to an article released today by the Pennsylvania Patient Safety Authority and published in its September Pennsylvania Patient Safety Advisory.

Diagnostic error is a diagnosis that is missed, incorrect, or delayed as detected by a subsequent definitive test or finding. Not all misdiagnosis results in harm and harm may be due to either disease or intervention.

Diagnostic errors are encountered in every specialty and are generally lowest (less than five percent) for certain specialties that rely on visual pattern recognition and interpretation (e.g., radiology, pathology, dermatology). Error rates in specialties that rely more on data gathering and the combination of different elements for a conclusive diagnosis are higher (10 to 15 percent).

"Diagnostic errors are often the first or second leading cause of medical malpractice claims in the United States," Dr. John Clarke, clinical director of the Pennsylvania Patient Safety Authority said. "They account for twice as many ongoing and settled claims as medication errors."


Friday, September 3, 2010

Effect of hemodialysis and peritoneal dialysis on redox status in chronic renal failure patients: a comparative study

ObjectiveTo investigate the effects of hemodialysis (HD) and periotoneal dialysis (PD) on oxidative stress in chronic renal failure patients (CRF).

Methods: 20 HD patients and 20 PD patients were compared with 20 end stage renal failure patients (CRF).

Results: Thiobarbituric acid reactive substances (TBARS) values were elevated in HD and decreased in PD compared to CRF (P<0.05). TBARS-VLDL and TBARS-HDL2 were decreased in HD and PD, compared to CRF (p<0.05). TBARS-LDL were higher in HD compared to CRF (p<0.05). No significant difference in TBARS- HDL3 values between the three groups. Carbonyls were increased in HD (p<0.05) and PD (p<0.01) compared to CRF. Plasma superoxide dismutase activity (SOD) was decreased in HD compared to CRF and PD (P<0.05). Glutathion peroxidase activity (GSH-Px) was decreased in HD and PD (P<0.005), compared to CRF. Decrease in catalase activity was noted only in PD compared to CRF (P<0.05). An increase in nitric oxide was noted in HD compared to CRF (p<0.05). Albumin concentrations were higher in HD and PD compared to CRF (P<0.001). READ MORE

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