Effects of 22-oxa-calcitriol on podocyte injury in adriamycin-induced nephrosis.

BACKGROUND: In various animal studies, vitamin D has been shown to have a significant effect on reduction of proteinuria and the progression of kidney disease. However, little is known on its renoprotective effect in adriamycin (ADR)-induced nephrosis mice. The present study was intended to determine the therapeutic benefit of 22-oxa-calcitriol (OCT), a vitamin D analog, in reducing proteinuria and its renoprotective effect, i.e. preventing podocyte injury on ADR-induced nephrosis mice. METHODS: Three experimental groups were used as follows: (1) nephrosis mice, established by a single intravenous injection of ADR; (2) ADR+OCT mice, nephrosis mice treated with OCT, and (3) mice treated only with OCT as the control group. Podocyte injury was assessed by podocyte apoptosis using the TUNEL assay, podocyte counting, podocyte-specific expressed protein by immunofluorescence and Western blot analysis, and foot process effacement using electron microscopy. RESULTS: Lower proteinuria was observed in ADR+OCT mice. Improvement in glomerulosclerosis and interstitial fibrosis, and prevention of glomerular hyperfiltration were observed in ADR+OCT mice. Immunofluorescence and Western blot analyses showed restoration of downregulated expression of nephrin, CD2AP and podocin. Nevertheless, dendrin expression was not restored. An insignificant reduction in podocyte numbers was found in ADR+OCT mice. Complete foot process effacement was partially prevented in ADR+OCT mice. CONCLUSIONS: The results indicate that OCT reduces podocyte injury and has renoprotective effects in ADR nephrosis mice.

A challenge to chronic kidney disease in Asia: The report of the second Asian Forum of Chronic Kidney Disease Initiative.

BACKGROUND: The Asian Forum of Chronic Kidney Disease Initiative started in 2007 in Hamamatsu, Japan when delegates from 16 countries joined together to facilitate collaboration in studying chronic kidney disease (CKD) in the Asia-Pacific region. Based on the outcome of the first meeting, the second meeting was organized as a consensus conference to frame the most relevant issues, and develop research recommendations and action plan. PROCEEDINGS: The meeting was held on 4 May 2008 as a pre-conference meeting to the 11th Asian Pacific Congress of Nephrology in Kuala Lumpur. This meeting consisted of three sessions: Session I was dedicated to the estimation of glomerular filtration rate and the standardization of serum creatinine measurements. Session II discussed specific considerations in the aetiology of and risk factors for end-stage renal disease in Asia. We concluded that there were regional specific problems that might lead to a very high prevalence of end-stage renal disease. Session III discussed the issue of facilitation of coordination and integration of the CKD initiative between developed and developing countries in the Asia-Pacific region. CONCLUSION: The following action plans were formulated: (i) validating the existing global estimated glomerular filtration rate equation or creating a new one using serum creatinine standardized by a central laboratory; (ii) establishing a pan-Asian CKD registry to facilitate risk analysis of CKD and its comorbidities; (iii) adapting existing clinical practice guidelines for CKD detection and management to address specific problems in this region; and (iv) working closely with other international professional organizations to promote manpower development and education in different aspects of CKD in developing countries.

Detection and prevention of chronic kidney disease in Indonesia: initial community screening.

AIM: This survey evaluated the prevalence of chronic kidney disease (CKD if estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m(2)) and its risk factors amongst subjects from urban and semi-urban areas. METHODS: History of hypertension, diabetes mellitus, kidney disease, cardio- and cerebrovascular diseases of subjects and their families was recorded. Blood pressure was determined as the mean of three readings in the sitting position and hypertension classified according to the Joint National Committee VII. Urinalysis was assessed using Combi 10R dipstick test. Random blood glucose and serum creatinine were measured in subjects with either hypertension, proteinuria, glycosuria and/or a history of diabetes. eGFR was calculated according Cockcroft-Gault (CG) adjusted by body surface area (BSA), Modification of Diet in Renal Disease (MDRD) and Chinese MDRD equations. RESULTS: Of 9412 subjects recruited, 64.1% were female. Persistent proteinuria was found in almost 3%. Systolic and diastolic hypertension was found in 10%, isolated systolic hypertension in 4.8% and isolated diastolic hypertension in 4.6%. CKD was found in 12.5% (CG), 8.6% (MDRD) or 7.5% (Chinese MDRD) of subjects with either hypertension, proteinuria and/or diabetes. Proteinuria, systolic blood pressure and a history of diabetes mellitus were independent predictors of impaired eGFR. Obesity and smoking history were found in 32.5% and 19.8%, respectively. CONCLUSION: The present study showed a high prevalence of CKD in representative urban and semi-urban areas and argues for screening and treatment of all Indonesians, particularly those at an increased risk of CKD.

End-stage renal disease in Indonesia: treatment development.

The number of cases of chronic kidney disease is growing rapidly, especially in the developing world. At a certain level of renal function, progression of chronic kidney disease to endstage renal disease (ESRD) is inevitable. ESRD has become a major health problem because it is a devastating medical condition, and the cost of treatment is a huge economic burden. This article presents data collected from 13 nephrology centers in response to specifically designed questionnaires. These centers were divided into 7 groups on the basis of geographic location. Previous data had given the impression that the incidence and prevalence of ESRD had increased, and the results of this study support these previous data. Since a national registry of ESRD has just been developed for Indonesia and we can present only limited data in this study, the numbers in this article underestimate the true incidence and prevalence rates. Although hemodialysis facilities have been developed rapidly, further development is still required. Continuous ambulatory peritoneal dialysis as an alternative renal replacement therapy (RRT) is only now being introduced. Kidney transplantation programs expand very slowly. RRT still imposes a high cost of treatment for ESRD; therefore, these treatments are unaffordable for most patients. Recently, government health insurance has covered financially strained families requiring RRT. Since the cost of RRT for ESRD has significantly increased over time, the management approach should be shifted from treatment to prevention.

Quality of life of HIV patients and influential factors.

AIM: To identify quality of life in HIV patients and to investigate associated factors. METHODS: A cross-sectional comparative study of HIV patients visiting the outpatient clinic at Cipto Mangunkusumo National Central Hospital and Dharmais Cancer Hospital was conducted between March and June 2003. Subjects were patients willing to fill in the SF-36 questionnaire, and willing to undergo physical examination and laboratory tests. Multivariate analysis was performed to identify the determinant factors that dominantly affect the quality of life in HIV patients. RESULTS: From 107 HIV subjects, we found poor quality of life. The score of HIV patients' quality of life components was as follows: mean physical function 49.2, social function 46.4, limitations due to physical factor 43.2, limitations due to emotional factor 48.8, mental health 50.7, energy 48.8, pain 54.7 and general health 42.7. The mean quality of life score for physical components in HIV patients was 47.45 while the mean quality of life score for mental components was 48.075. Factors that dominantly contribute to the quality of life in HIV patients are, respectively, the presence of opportunistic infection (p=0.001 OR=5.297 CI 1.974-14.218) and ARV therapy for more than 3 months (p=0.048 OR=4.487 CI 1.011-19.908). CONCLUSION: Both physical and mental components in HIV patients demonstrated poor quality of life. Factors that dominantly contribute to the quality of life in HIV patients are, the presence of opportunistic infection and ARV therapy for more than 3 months.

Incidence, prevalence, treatment and cost of end-stage renal disease in Indonesia.

End-stage renal disease (ESRD) has significantly increased in developing countries such as Indonesia. Chronic glomerulonephritis is still the leading cause of ESRD, while the numbers of diabetes mellitus patients have significantly risen. Data presented in this article were obtained from various nephrology centers in response to the specific questionnaires distributed by Indonesian Society Nephrology (InaSN). These data give the impression that both incidence and prevalence rates in various areas of Java and Bali are increasing over time, although the rates presented here are far lower than expected. Hemodialysis is available in most parts of the country. Continuous ambulatory peritoneal dialysis (CAPD) and renal transplantation programs have been performed in few nephrology centers. Costs for dialysis and renal transplantation are still unaffordable for most ESRD patients. Since the cost burden has significantly increased, nephrology services should be changed from curative to the preventive medicine. Currently InaSN plans to have a detection and prevention program for chronic kidney disease.

The influence of depression on the quality of life of male patients post acute myocardial infarct.

AIM: Assess the effect of depression on post-acute myocardial infarction (AMI) quality of life in male patients. METHODS: We conducted a prospective cohort study on male patients presenting with AMI at the ICCU of Cipto Magunkusumo and Persahabatan Hospitals between October 2002 and August 2003. One day prior to hospital discharge, each respondent was requested to fill out th BDI and modified SF-36 questionnaires. Two months afterwards, each respondent was re-evaluated by filling out the same questionnaires. Bivariant analysis was performed to evaluate the correlation between depression, other determinants, and quality of life. RESULTS: From 30 respondents (15 respondents with depression and 15 without depression), we found that 4 of the 15 patients form the non-depressed group (26.7%) developed depression 2 months post AMI. Depression 2 months post AMI has a statistically significant correlation with a reduced quality of life in male patients (RR=2.35; 95%CI = 1.04-5.35; p=0.030). CONCLUSION: Post-AMI depression has a statistically significant correlation with a reduced quality of life among male patients. This finding supports the hypothesis that depression can have a negative influence on post-AMI patients.