Background: Patients with diabetic or hypertensive kidney disease rarely undergo kidney biopsy because nephrologists commonly believe that biopsy-related risk outweighs potential benefits of obtaining histologic information to guide clinical decisions. Although kidney function is acutely regulated, histologic changes such as interstitial fibrosis, tubular atrophy, and glomerulosclerosis may represent chronic kidney damage, and thus might provide additional information about disease severity. However, whether histologic analysis provides information complementary to clinically used kidney function measurements, such as estimated glomerular filtration rate (eGFR) and proteinuria, is unclear.
Methods: We performed a standardized semiquantitative histologic analysis of 859 nephrectomies obtained from individuals with or without diabetes mellitus or hypertension and varying degrees of kidney dysfunction. Changes in glomeruli, tubules, interstitium, and the vasculature were scored using 17 descriptive parameters in a standardized manner. We used multivariable linear and logistic regression analyses and unbiased, hierarchical clustering to assess associations between histologic alterations and clinical variables.
Results: At chronic kidney disease (CKD) stages 3-5, eGFR estimated reasonably well the degree of glomerulosclerosis and interstitial fibrosis and tubular atrophy (IFTA). In patients with CKD stages 1-2, the degree of histologic damage was highly variable and eGFR poorly estimated the degree of such damage. Individuals with diabetes mellitus, hypertension, or Black race had significantly more glomerulosclerosis, IFTA, or both at the same eGFR level. Inclusion of glomerulosclerosis improved the kidney function decline estimation even at early disease stages.
Conclusions: Histologic analysis is an important complementary method for kidney disease evaluation, especially at early disease stages. Some individuals present with relatively severe structural damage despite preserved eGFR.
Hemophagocytic lymphohistiocytosis (HLH) is an aggressive syndrome of immune dysregulation driven by abnormal lymphocyte and macrophage activation and proliferation. CD8+ T lymphocytes secrete interferon-gamma (IFN-γ) on activation, which then causes DTT serves on advisory boards for Janssen, Amgen, La Roche and Sobi.MPL is an advisory board member for Octapharma and Shionogi and a consultant for Amgen, Novartis, Shionogi, Dova, Bayer, and Astra Zeneca. DM is consultant for, receives royalties from, and owns options at Omixon.
Hypertension is the most prevalent cardiac risk factor. In the United some estimates show 60% of 60-year-olds, 70% of 70-year-olds, an 80% of 80-year-olds being hypertensive. Often, blood pressure becomes resistant or refractory. Device therapy represents a new approach to treating this disease. The best studied of these nonpharmacologic approaches to resistant/refractory hypertension include renal denervation, carotid sinus stimulators, and central arteriovenous fistula placement. This chapter will focus on novel device therapy and literature review of its use in clinical trials.
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