Type I diabetics do not derive cardiovascular benefit fromtransplantation

A recent study has found that patients with Type I diabetes who underwent combined kidney and pancreas transplantation were found to have continued elevated levels of markers of endothelial dysfunction. The Study done in Austria comprised five different groups matched for age, gender, and body mass index. The groups comprised 10 type 1 diabetes SPK patients with non-diabetic blood glucose levels, 10 type 1 diabetes patients with poor glycemic control, 10 type 1 diabetes patients with good glycemic control, six non-diabetic patients after kidney-transplantation, and 10 non-diabetic controls. Even though glucose levels normalised in the diabetic group after transplantation certain very specific indices of endothelial dysfunction remained elevated against controls who never had diabetes.

This study should serve to increase vigilance in such patients after transplantation because they are still at risk for complications of diabetes such as stroke and heart attack despite transplantation. Despite the fact that previous studies demonstrated a significant benefit in terms of cardiovascular disease between patients with combined pancreas and kidney transplant and those that only received kidney transplantation.


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Patient Education: What is the link between Lupus and Kidney disease.

Diffuse proliferative lupus nephritis (Photo credit: Wikipedia)

Systemic lupus is a disease whose exact cause remains elusive to modern medical research. What is known about lupus is that it is a disease that turns the normal immune system against itself and the rest of the body. The immune system contains several different type of cells. The B and T cells are the brains of the immune system a lot of decision making about what to attack takes place between these cells and the more basic cells such as macrophages.

The macrophages essentially act as a mobile police force travelling throughout your body and tries to envelop all abnormal bacteria and other invaders. Once inside the macrophage the invading organism is imprisoned in its own space within the cell. The cell then injects chemicals that it produces into the area with the invader destroying it, if everything is going according to plan.

The invader once destroyed is then broken down into its constituent pieces and these pieces are presented like trophies on the surface of the cell so that any passing cell can see them. This only becomes important if a passing B cell or T cell happens to notice the trophy. In which case the B cell and T cell communicate with the macrophage examine the trophy and if it is deemed to have arisen from a foreign organism then the B cell designs a perfect weapon to kill it in future called an antibody. If the B and T cells confer and the trophy is thought to have been derived from the self then they USUALLY dont bother to form antibodies.

In lupus there is a defect of one or several of the above processes which are in fact far more complex than outlined. The end result is the B cell is unable to identify self from invader and decides to produce antibodies against anything a macrophage happens to be carrying.

Hence the disease can affect any tissue of the body as macrophages are present within all tissues. When this sequence of events targets the kidney the antibodies produced create an inflammatory reaction at the target site within the specific structure targeted within the kidney.

One of the first signs of this when you go to get your check up is increased protein in the urine. This occurs because the inflammatory reaction affecting the kidneys damage a very important part of the kidney filter that usually produces urine called the "basement membrane" this allows leakage of substances out of the blood where they should have remained. If damage is bad enough blood will also leak through. If You have a significant amount of blood and protein in the urine then you will have what is called glomerulonephritis, which basically means inflammation of the kidney structure known as the glomerulus. The glomerulus being the important filter that starts the process of urine formation.

When this inflammation occurs in patients with lupus it could very well be called lupus glomerulonephritis, instead it is shortened to Lupus nephritis. The severity of the inflammation determines the severity of the nephritis. And as with all things where scientists are involved they have described subsets.

CLASS I disease is mild.
CLASS II disease is also mild.
CLASS III disease can be moderately severe
CLASS IV disease is usually considered the most severe
CLASS V disease may be considered less than class IV in severity but is generally treated the same way.
CLASS VI disease generally represents scarring of the kidney or old inflammation.

The class of disease is not immediately apparent when your doctor asks about your history, examines you or even after the blood tests. The class can only be obtained by taking a tiny piece of the kidney from the body to be analysed in the lab. This is called a renal biopsy.

The treatment options will then be explained to you.

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Herbal corner: Can green tea prevent kidney stones

Red, black and green tea (Photo credit: mat.teo)

tea is more than a wonderful soothing beverage.....

Nephrolithiasis otherwise known as kidney stones are responsible for a very significant number of health issues. The lifetime risk of kidney stone formation is approximately 13% in men and 7% in women. The yearly economic cost of kidney stones has been estimated at 5.3 billion in the United States alone.

Anyone who has had a kidney stone knows it is not a pleasant occurence and would do almost anything to prevent them from recurring. Unfortunately most people are unable to comply with the large volume of water intake required to prevent stone formation. And drug therapy has provided mixed results, with some of the drugs intended to prevent stone formation causing different types of stones themselves.

Green tea has multiple health benefits but does it increase or decrease the risk of kidney stone formation?

A study published in the journal of urology has found that green tea reduces the formation of calcium oxalate stones which are the most common form of stone. It is though that this is brought about by the antioxidant effects of green tea. These finding are very similar to findings of other investigators.

How many cups of green tea should you drink, how hot should the water be, is there a difference in green teas obtained from China or Japan. There are no satisfactory answers to these questions yet. However in populations studies from the east it is proposed that the benefit of green tea particularly in prevention of cancer is approximately 5 to 6 cups per day. If the mechanism of this effect is the same then antioxidant effect may be maximal or near maximal at this dose. This should therefore be a reasonable starting point.

Patient Education: How do you lower your risk of Chronic Kidney Disease.

LAS VEGAS, NV - JANUARY 07: Dan Radin displays the USB Blood Pressure Monitor from Ion Health at the 2011 International Consumer Electronics Show at the Las Vegas Convention Center January 7, 2011 in Las Vegas, Nevada. The USD 70 device measures systolic and diastolic pressure and pulse rates and has an internal memory capable of holding up to 352 readings. The data can be uploaded via USB 2.0 to a computer where it can be used with Ion Health Suite software. CES, the world's largest annual consumer technology tradeshow, runs through January 9 and is expected to feature 2,700 exhibitors showing off their latest products and services to about 126,000 attendees. (Image credit: Getty Images via @daylife)

If you have diabetes and hypertension then you are at higher than average risk for chronic kidney disease. You should be aware of this and be very involved with your treatment, you must help your doctor to care for you!!.

Ask pertinent questions such as.

Q: Have you checked my kidneys? if so how are they doing.

Q: Is my Blood sugar within the normal range or at a range that reduces my risk of kidney disease developing?

Q:Is my Blood Pressure in the normal range. If not what can we do to make it so as that will reduce my chances of developing chronic kidney disease.

Q:My relative had kidney disease I am worried about developing it is there anything i can do to find out if i am at risk?

It is important to lead a healthy lifestyle exercise at least three times per week and eat a healthy balanced diet.

It is important to understand certain concepts.

SEELOW, BRANDENBURG - AUGUST 08: Country doctor Dieter Baermann measures the blood sugar level of an elderly patient in the patient's home on August 8, 2011 in Sachsendorf near Seelow, Germany. Baermann works in the state of Brandenburg in eastern Germany, a region that is struggling with a shortage of doctors in rural areas. Critics charge that current laws actually discourage doctors from taking up posts in rural areas, and the German government is debating a new law intended to reverse the trend. Many doctors across Germany complain about a legal system that they claim burdens them with too many costs and hampers their ability to provide the best care. (Image credit: Getty Images via @daylife)

Normal blood pressure is an arbitrary definition set at less than 120/80 mmHg. However large studies have shown that if blood pressure is lowered even further to just before the point of having symptoms of low blood pressure such as dizzyness and fainting then health benefits continue to accrue and your risk of stroke heart attack and chronic kidney disease improves.

When checking your blood sugar one of the most informative tests is a test of average blood sugar over the last 3 to 4 months. This is called the HbA1c or glycosylated Hb. For every point below 7 that this test registers you accrue benefits such as decreased heart attack and stroke and also decreased chronic kidney disease.

Having increased protein in your urine is not ok particularly if this is a recurrent problem. This could be a sign of early kidney disease. The earlier your disease the lower the protein is usually. Tests of microscopic amounts of protein in the urine can now be performed that detects very early kidney disease. Ask about the urine microalbuminuria test.

If you are male and above 45 having your regular prostate exam may reveal early enlargement which may obstruct outflow of the kidney. If early enough it is reversible and can prevent chronic kidney disease.

Infections of the bladder occur more frequently in women that men. Recurrent infections should never be treated as business as usual. A cause should be sought and if found may reduce your risk of chronic kidney disease from infection.

Males regardless of age should never have urinary tract infection this is never to be treated as business as usual or simply treated with a course of antibiotics. Referral to a specialist in urology and a detailed work up needs to be done to identify the cause so that it can be corrected before kidney damage occurs.