A History of Uremia Research.

The history of uremia research begins with the discovery of urea and the subsequent association of elevated blood urea levels with the kidney disease described by Richard Bright, a well told story that needs no recounting. What this article highlights is how clinical and laboratory studies of urea launched the analysis of body fluids, first of urine and then of blood, that would beget organic chemistry, paved the way for the study of renal function and the use of urea clearance to determine "renal efficiency," provided for the initial classification of kidney disease, and clarified the concepts of diffusion and osmosis that would lead to the development of dialysis. Importantly and in contrast to how the synthesis of urea in the laboratory heralded the death of "vitalism," the clinical use of dialysis restored the "vitality" of comatose unresponsive dying uremic patients. The quest for uremic toxins that followed has made major contributions to what has been facetiously termed "molecular vitalism." In the course of these major achievements derived from the study of urea, the meaning of "what is life" has been gradually liberated from its past attribution to supernatural forces (vital spirit, archaeus, and vital force) thereby establishing the autonomy of biological life in which the kidney is the master chemist of the living body.

[Protective effects of Paecilomyces hepiali Cs-4 on rats with adriamycin-induced nephropathy].

OBJECTIVE: To study the renal protective effect of Paecilomyces hepiali Cs-4 (Abbr. to Cs-4) on rats with adriamycin-induced nephropathy (AIN). METHODS: Twenty-four male SD rats were randomly divided into four groups: the control group (A), the model group (B), the Benazepril group (C), and the Cs-4 group (D). AIN rat model was established by left unilateral nephrectomy and repeated caudal vein injection of adriamycin. Gastric perfusion of Cs-4 [500 mg/( kg x d)] and Benazepril [4 mg/( kg x d)] was given respectively to the groups D and C, starting from 1 week after modeling. Blood biochemical indices including blood urea nitrogen (BUN), serum creatine (Scr) and 24-hour urinary protein excretion (24 h-UP) were assessed 4 and 8 weeks after medication. Rats were sacrificed at the end of 8-week medication, their renal tissue was get for pathological examination with electric microscopy, the expressions of fibronection (FN), collagen IV (COL-IV ) and osteopont (OPN) in renal tissue were assessed by immunohistochemistry. RESULTS: Levels of 24h-UP, BUN, Scr, mesengial matrix percentage, as well OPN, FN, COL-IV were significantly lower in group D than in group B (P < 0.05); and the fat metabolic disorder was improved in group D (P < 0.05). CONCLUSION: Cs-4 displays its renal protective action in rats with AIN through reducing the urinary protein excretion, correcting lipid metabolic disturbance, inhibiting the over accumulation of extracellular matrix, improving the pathological damage of kidney, thus restoring the renal function.

Armenian medicine and diseases of the kidney.

The history of Armenian medicine is that of the common practice of medicine in caring for the sick through the ages, using mainly local medicinal herbs and natural products. Over the years, its practitioners persistently collected and recorded an expanding body of information on therapeutics and put it to use for the daily medical care of ordinary folks. Armenian medicine developed around the church and monasteries, which flourished during episodic periods of peace in an otherwise tumultuous and warring region. However, unlike the monastic medicine that developed in Europe, Armenian medicine maintained the rationality it had acquired from Greek medicine, and never resorted to magic, myth or amulets. Nor did it acquire or import saints. Armenian medicine is a classic example of the evolving art of therapeutics, whose record is preserved in extant manuscripts, saved over the centuries in monasteries, and now preserved in accessible collections.

Role of gabapentin in the treatment of uremic pruritus.

OBJECTIVE: To evaluate the efficacy of gabapentin for the treatment of uremic pruritus (UP). DATA SOURCES: Literature retrieval was accessed through MEDLINE (1950-March week 3, 2008; In-Process & Other Non-Indexed Citations, April 1, 2008) and International Pharmaceutical Abstracts (1970-March 2008) using the terms gabapentin, pruritus, itch, urem$ (truncated), dialysis, and kidney disease. The Google Scholar search engine was used to identify articles that MEDLINE did not capture with the described search terms. Additionally, reference citations from publications identified were reviewed. STUDY SELECTION AND DATA EXTRACTION: All articles in English and studies conducted in humans were identified and evaluated. DATA SYNTHESIS: UP is an unpleasant itching sensation that affects approximately 30% of patients on hemodialysis (HD). The current mainstays of therapy include antihistamines and topical therapies, although many patients remain symptomatic despite these treatments. Alternative therapeutic approaches, including topical, oral, and intravenous drugs; dialysis modifications; homeopathic therapies; and physical treatments have been used, but few evidence-based studies exist to support their utility. Gabapentin has been evaluated for the treatment of UP in 2 small, randomized, placebo-controlled studies, 1 pilot evaluation, and 1 index case. Gabapentin has demonstrated efficacy in the treatment of multiple types of itch and shows promise in treating patients with UP who are unresponsive to standard therapies. All of the controlled studies consisted of 4 weeks of active treatment, and no patients discontinued gabapentin due to adverse events. The most common adverse events noted in these trials were consistent with gabapentin's safety profile (dizziness, somnolence, fatigue, nausea). CONCLUSIONS: Available data support the use of gabapentin as a well-tolerated and effective treatment option for patients with UP who are unresponsive to traditional therapies. Further well-designed trials are warranted to establish the most appropriate dosing regimen in patients on HD.

Clinical pharmacokinetics of the non-depolarising muscle relaxants.

Muscle relaxants are of great benefit to the anaesthetist as adjuncts to anaesthesia. These drugs are used to facilitate endotracheal intubation and to reduce muscle tone during surgery, and may also find application in assisting ventilator care in the intensive care situation. The pharmacological effect of the relaxants may be readily assessed by the anaesthetist by means of a variety of techniques to quantify muscular activity in response to electrical stimulation. A number of factors may modify the effects of the muscle relaxants including anaesthetic agents, hypothermia, patient age and disease status and a variety of drugs. The disposition kinetics of the muscle relaxants have been well characterised although information on protein binding and placental transfer is somewhat scanty. A common characteristic of their pharmacokinetics is multicompartmental behaviour. Clearance of the relaxants ranges from total elimination by the kidneys (gallamine) to substantial hepatic clearance (fazadinium), and thus their clearance may be adversely affected by renal or hepatic disease. Dosage regimens have been designed using knowledge of the disposition kinetics of the relaxants to provide for continuous adequate relaxation during prolonged surgical procedures. With the use of sophisticated pharmacokinetic and pharmacodynamic models good relationships have been demonstrated between plasma concentrations of the relaxants throughout the entire range of relaxant response.

The neuromuscular blocking action of vecuronium in normal patients and in patients with no renal function and interaction vecuronium-tobramycin in renal transplant patients.

The new short acting steroid muscle relaxant vecuronium was tested clinically in 42 surgical patients and compared in three different groups of patients: normal patients, renal graft patients who received tobramycin preoperatively and other anephric patients undergoing surgery. Twenty-five percent recovery of initial twitch height as measured by NTM was significantly longer in the renal graft group than in the two other groups where recovery time is normal. Cardiovascular parameters were recorded before and after the injection of vecuronium. Reversal of the neuromuscular block was spontaneous or pharmacologically evoked by neostigmine. Clinical recovery was complete in all patients and there was no residual block.

[Experimental studies of Chinese taihe chicken on effects of "Qi" reinforcing and "Yin" nourishing].

The "Qi" deficiency and "Yin" deficiency rats were fed with Chinese Taihe Chicken or common Chicken. The results showed: Chinese Taihe Chicken and common Chicken could all improve in part the "Qi" deficiency of rats caused by forced swimming, furthermore, the effect of Chinese Taihe Chicken was better than that of common Chicken. Chinese Taihe Chicken could obviously reduce the activity of adenosine triphosphatase of kidney tissue of "Yin" deficiency rats caused by injecting thyroxine. It suggested that Chinese Taihe Chicken could nourish the "Yin".

Tribulus terrestris hydroalcoholic extract effect on cisplatin-induced apoptosis in mice kidney / Efecto del extracto hidroalcohólico de Tribulus terrestris sobre la apoptosis Inducida por cisplatino en el riñón de ratones

Cisplatin (EBEWE Pharma, Unterach, Austria) is an anti-cancer drug used in chemotherapy. One of the limiting major side effects of cisplatin is nephrotoxicity. Tribulus terrestris (TT) has been used as an synthetic or herbal protective agents for kidney disorders. The present study amid to investigate the Tribulus terrestris Hydroalcoholic extract effect on cisplatin-induced apoptosis in mice kidney. Male adult mice (n= 30) were divided into control group and 4 experimental groups (n= 6). Control group received saline, the first experimental group received cisplatin (5.5 mg/kg) and other three experimental groups received cisplatin (5.5 mg/kg) and different doses of hydroalcoholic extact of TT (100, 300 and 500 mg/kg i.p) respectively. The kidneys were removed after 4 days of injections, and TUNEL assay on mice's kidneys were performed. Weights of body and kidneys and apoptotic index were assessed. Data analysis was performed using one-way ANOVA followed by Tukey's post hoc test. The results showed that cisplatin lead to a reduction in the weight of body and kidney (P <0.01), and increased apoptotic index significantly compared to the control group (P <0.001), while in treated groups with TT, the weights of body and kidney were significantly higher compared with cisplatin group, but apoptotic index did not show significant differences. These parameters reached normal range after administration of fruit extracts of TT for 4 days. The study demonstrates that extract of TT could have protective effect on cisplatin- induced apoptosis of kidney. This may be related to the presence of antioxidant components acting via a multitude of central and peripheral mechanisms.

El cisplatino (EBEWE Pharma, Unterach, Austria) es un medicamento contra el cáncer utilizado en quimioterapia. Uno de los principales efectos secundarios limitantes del cisplatino es la nefrotoxicidad. Tribulus terrestris (TT) ha sido utilizado como agente protector sintético o herbal para los trastornos renales. El objetivo fue investigar el efecto del extracto hidroalcohólico de TT sobre la apoptosis inducida por cisplatino en el riñón de ratones. Se utilizaron ratones adultos machos (n= 30), que fueron divididos en 4 grupos, un control y tres grupos experimentales (n= 6). El grupo control recibió solución salina; el primer grupo experimental recibió cisplatino (5,5 mg/kg) y los otros tres grupos experimentales recibieron cisplatino (5,5 mg/kg) con diferentes dosis de extracto hidroalcohólico de TT (100, 300 y 500 mg/kg vía ip) respectivamente. Los riñones fueron retirados después de 4 días de aplicadas las inyecciones, y se realizó el ensayo TUNEL en los riñones. Se evaluó el peso corporal de los ratones, el peso de los riñones y el índice de apoptosis. El análisis de datos se realizó mediante ANOVA de un factor seguido por la prueba post hoc de Tukey. Los resultados mostraron que el cisplatino con plomo provocó una reducción en el peso corporal y el riñón (P <0,01) y un aumento significativo del índice de apoptosis en comparación con el grupo control (P <0,001), mientras que en los grupos tratados con TT, los pesos corporales y de los riñones fueron significativamente mayores en comparación con el grupo de cisplatino, pero el índice de apoptosis no mostró diferencias significativas. Estos parámetros alcanzaron niveles normales después de la administración de extracto de TT durante 4 días. El estudio demuestra que el extracto de TT podría tener un efecto protector sobre la apoptosis inducida por cisplatino en el riñón, que podría estar relacionado con la presencia de componentes antioxidantes que actúan a través de múltiples mecanismos centrales y periféricos.

El riñón en la malaria: de la patogénesis a las manifestaciones clínicas / The kidney in malaria: From pathogenesis to clinical symptoms

La malaria o paludismo, enfermedad causada por protozoos parásitos de género Plasmodium , se considera un gran problema de salud pública mundial por sus elevadas tasas de morbimortalidad. Las manifestaciones clínicas de esta infección van desde un síndrome febril agudo hasta un cuadro de malaria complicada que afecta órganos específicos, pudiendo progresar a una falla multisistémica que comprometa la vida del paciente. En la malaria, el riñón es un órgano susceptible de daño por mecanismos fisiopatológicos directos del plasmodio como el secuestro de glóbulos rojos parasitados, la obstrucción de la microcirculación y la activación del sistema inmune; además, por efectos indirectos hematológicos, hepáticos y metabólicos. La lesión renal en malaria se ha informado en Colombia hasta en el 31% de los pacientes con malaria grave; incluye la lesión renal aguda y el síndrome nefrótico, cada uno con manifestaciones clínicas, implicaciones terapéuticas y factores pronósticos propios. La lesión renal aguda es la condición más frecuente y puede llevar a una acidosis metabólica grave, daño renal crónico e incluso, cuando hace parte de una falla multiorgánica, asociarse con mortalidad que alcanza tasas de entre 40 y 50%. Un mejor entendimiento de la fisiopatología de la lesión renal en la malaria permitirá reconocer las manifestaciones clínicas para hacer un diagnóstico temprano e iniciar un tratamiento oportuno, con los beneficios que esto conlleva para la evolución y pronóstico del paciente.

Guatteria gaumeri, Malmea depressa o Yumel, una revisión sobre su historia, sus propiedades y su uso en la homeopatía / Guatteria gaumeri, Malmea depressa or yumel, a review of its history, its properties and its use in homeopathy

El elemuy, Guatteria gaumeri o Malmea depressa es un árbol que habita en México y Centroamérica, y que debido a las propiedades medicinales de su corteza y su raíz ha sido aprovechado desde la época prehispánica para atender afecciones renales, diabetes mellitus tipo II e hipercolesterolemia, entre otras enfermedades. A principios del siglo XX llamó la atención del médico homeópata mexicano Manuel A. Lizama, quien probó su uso durante una década y registró sus observaciones en el Prontuario de materia médica, publicado en 1913. Desde entonces se han realizado diversas investigaciones dentro y fuera del ámbito homeopático que han confirmado y precisado cuál es la acción medicamentosa de la alfa-asarona y otros componentes del elemuy, pero también han sugerido nuevos atributos que sería conveniente comprobar o descartar a través de estudios científicos. El presente texto hace un recorrido por algunos de los artículos representativos que se han generado sobre la Guatteria gaumeri o Malmea depressa, con la finali ad de que médicos, estudiantes e investigadores actualicen o mejoren sus conocimientos...

The Elemuy, Guatteria gaumeri or Malmea depressa is a tree that grows in Mexico and Central America, and because of the medicinal properties of his bark and roots, it has been used since pre-hispanic times to treat kidney disease, type II diabetes mellitus and hypercholesterolemia, among other diseases. In the early twentieth century it drew the attention of Dr. Manuel A. López a Mexican homeopath, who proved it´s use for a decade and recorded his observations at the Prontuario de Materia Medica, published in 1913. Since then there have been performed several research works into, and out of the homeopathic field that have confirmed and specified the pharmacological action of the alpha-asarone among other components of the Elemuy, but also, new pharmacological properties have been suggested that it would be important to test through scientific works. This text takes us through some representative articles that have been generated on the Guatteria gaumeri or Malmea depressa, in order that doctors, students and researchers update or improve their knowledge about this theme...

Guatteria gaumeri, Malmea depressa o Yumel, una revisión sobre su historia, sus propiedades y su uso en la homeopatía / Guatteria gaumeri, Malmea depressa or yumel, a review of its history, its properties and its use in homeopathy

El elemuy, Guatteria gaumeri o Malmea depressa es un árbol que habita en México y Centroamérica, y que debido a las propiedades medicinales de su corteza y su raíz ha sido aprovechado desde la época prehispánica para atender afecciones renales, diabetes mellitus tipo II e hipercolesterolemia, entre otras enfermedades. A principios del siglo XX llamó la atención del médico homeópata mexicano Manuel A. Lizama, quien probó su uso durante una década y registró sus observaciones en el Prontuario de materia médica, publicado en 1913. Desde entonces se han realizado diversas investigaciones dentro y fuera del ámbito homeopático que han confirmado y precisado cuál es la acción medicamentosa de la alfa-asarona y otros componentes del elemuy, pero también han sugerido nuevos atributos que sería conveniente comprobar o descartar a través de estudios científicos. El presente texto hace un recorrido por algunos de los artículos representativos que se han generado sobre la Guatteria gaumeri o Malmea depressa, con la finali ad de que médicos, estudiantes e investigadores actualicen o mejoren sus conocimientos. (AU)

The Elemuy, Guatteria gaumeri or Malmea depressa is a tree that grows in Mexico and Central America, and because of the medicinal properties of his bark and roots, it has been used since pre-hispanic times to treat kidney disease, type II diabetes mellitus and hypercholesterolemia, among other diseases. In the early twentieth century it drew the attention of Dr. Manuel A. López a Mexican homeopath, who proved it´s use for a decade and recorded his observations at the Prontuario de Materia Medica, published in 1913. Since then there have been performed several research works into, and out of the homeopathic field that have confirmed and specified the pharmacological action of the alpha-asarone among other components of the Elemuy, but also, new pharmacological properties have been suggested that it would be important to test through scientific works. This text takes us through some representative articles that have been generated on the Guatteria gaumeri or Malmea depressa, in order that doctors, students and researchers update or improve their knowledge about this theme. (AU)

Some plants described by Dioscorides for the treatment of renal diseases.

The original De Materia Medica of Dioscorides has been lost, but several copies remain. Unlike the original, these contain an alphabetical listing of plants and color plates. The source for the plants described in this paper is a 16th century translation into vernacular Italian and the Codex Neapolitanus. In all, 12 plants listed by Dioscorides for treatment of renal diseases can be positively identified.

Prolonged curarisation in the presence of renal impairment.

Prolonged curarisation in the presence of renal failure occurred in six cases where pancuronium was used, and one case where alcuronium was used. The cases are presented with a brief review of the literature. Pancuronium must be used with great caution if postoperative reversal problems are to be avoided. Greater use of adjuvants will reduce requirements and may eliminate the problems encountered in renal failure.

Plasma binding of pancuronium: effects of age, sex, and disease.

The extent of pancuronium binding in plasma in controversial due to a lack of definitive studies in human plasma. The degree of pancuronium binding in human plasma and the concomitant effects of age, sex, and renal disease on drug binding were determined by equilibrium dialysis using [3H]pancuronium. The free fraction of pancuronium was 93.2 +/- 1.6% in male subjects and 88.9 +/- 2.5% in adult nonpregnant female subjects, indicating that pancuronium is not highly protein bound. The free fraction in newborns and their mothers was 91.0 +/- 1.8% and 89 +/- 1.3%, respectively. There were no significant differences between the plasma binding of pancuronium in men, nonpregnant women (whether on oral contraceptives or not), pregnant women, or neonates. The free fraction of pancuronium was unaltered (90.7 +/- 2.1%) in patients with severe renal disease. We therefore conclude that the binding of pancuronium in human plasma is very low and that age, sex, oral contraceptives, pregnancy, and renal disease do not influence the plasma binding of this drug.

Disposition and urinary excretion of vecuronium bromide in anesthetized patients with normal renal function or renal failure.

The effect and plasma concentrations of vecuronium bromide were measured in normal patients after an intravenous dose of 50, 100, or 150 micrograms/kg and in patients with renal failure after 50 or 100 micrograms/kg. Urinary excretion of vecuronium was studied in normal patients after the 150 micrograms/kg dose. Pharmacokinetic parameters of patients with or without renal failure were similar. No metabolites of vecuronium were found in the plasma. Twenty percent of vecuronium was excreted unchanged in the urine; 5% as the 3-hydroxy derivative. No other metabolites of vecuronium were found in the urine. Increasing doses of vecuronium shortened the onset, but prolonged the duration of action and the recovery rate, to a similar extent in patients with or without renal failure. It was concluded that the disposition of vecuronium was best described by a three compartment model. Both the disposition and the effect of vecuronium are only marginally disturbed by renal failure.