Renal tubular handling of potassium in children with insulin-dependent diabetes mellitus

To clarify the mechanism by which renal potassium (K) excretion is reduced in children with insulindependent diabetes mellitus, we studied two groups of patients: (A) at diagnosis and (B) after at least 1 year of follow-up. Group A (15 children) was studied twice: on the day of admission and after 1 month of insulin therapy. On admission, urinary K excretion, fractional K excretion, and transtubular K concentration gradient (TTKG) were significantly decreased, but became normal after extended insulin therapy. TTKG was inversely correlated with blood glucose (P<0.001) and hemoglobin A_1c (HbA_1c,P<0.001). Group B (73 children with a mean follow-up of 54±36 months) was subdivided according to the TTKG: 30 patients had a low TTKG<4.0 (median 3.2) and 43 patients had a normal TTKG4.0 (median 5.2). Patients with a low TTKG and those with a normal TTKG had an identical duration of follow-up and similar values for plasma renin activity, aldosterone concentration, calciuria, magnesiuria, albumin excretion rate, and creatinine clearance. However, those with a low TTKG had significantly higher blood HbA_1c levels, urine volume, and glucosuria. Logistic regression analysis showed that the only independent variables predicting a low TTKG were blood HbA_1c and glucosuria (P<0.001). These data confirm that a reduced renal K excretion is a characteristic feature of diabetic children; this is reversible with appropriate insulin therapy, largely depends on the metabolic control of the disease, and, specifically, on the degree of hyperglycemia and/or glucosuria.     

Lack of evidence of hypervolemia in children with insulin-dependent diabetes mellitus

Hypervolemia is considered to play a major role in the pathogenesis of diabetic vasculo- and nephropathy. The aim of our study is to determine whether children and adolescents with insulin-dependent diabetes mellitus (IDDM) experience alterations in blood volume (BV) before onset of apparent nephropathy. BV (calculated as the sum of measured plasma volume (PV) and red cell volume (RCV)) was determined in 31 children (9–16 yr) with a mean duration of IDDM of 6.6 yr and without microalbuminuria. Due to dependence of these values on age, size and sex, all data were normalised for body size parameters. While no statistical difference for BV normalised for lean body mass (LBM) (86.98±9.5 ml/kg) was found in diabetic children compared with our control population (84.91±12.08 ml/kg), a difference could be shown when normalised for body surface area (BSA) (diabetic children 2.37±0.3 L/m²; control population 2.15±0.38 L/m², p=0.002). Increased BV is only present when normalising for BSA and not for the theoretical superior LBM-index. Because the study population exhibited a poor glycemic control (HbA1c 10.2±2.4 %), an influence of glucosuria-induced polyuria on BV cannot be excluded. Taking into account these limitations our data do not confirm the presence of hypervolemia before onset of diabetic nephropathy.     

The role of the pediatric nephrologist in the care of children with diabetes mellitus

The pediatric nephrologist has traditionally not been involved in the care of the diabetic child since diabetic nephropathy presents in adulthood. Recent studies suggest that diabetic kidney disease develops silently during childhood. Measurement of urinary albumin excretion (UAE) allows earlier detection of patients at risk of nephropathy, often in adolescence. In addition to diabetic nephropathy, diabetic children are at risk of urinary tract infections, renal papillary necrosis, and various forms of glomerulonephritis. The role of the pediatric nephrologist in the care of the child with diabetes might include advising on the administration and interpretation of screening for UAE and the measurement and interpretation of glomerular filtration rate, and blood pressure. Children with evidence of renal dysfunction should be evaluated and treated by the pediatric nephrologist. Frequently, renal biopsy will be necessary in these patients. Future research may allow the detection of diabetic kidney disease earlier in childhood, further expanding the role of the pediatric nephrologist. In particular, early renal biopsy may eventually be used to select those patients at risk of diabetic nephropathy for specific treatment alterations.     

Urinary dopamine response to angiotensin II is not abnormal in type 1 (insulin-dependent) diabetes mellitus

To examine the interaction between angiotensin II (ANGII) anddopamine in type I diabetes mellitus, urinary dopamine excretionwas examined during ANGII infusion in 15 diabetic patients and10 control subjects after pretreatment with lithium 750 mg andplacebo. The antinatriuretic response and the urinary dopamineresponse to ANGII did not differ within or between the two groupson each study day. No correlation was observed between the decrementsin urinary sodium excretion and urinary dopamine output duringANGII infusion in either group. The effect of insulin on urinarydopamine excretion was studied separately in seven non-diabeticsubjects; sodium and potassium retention occurred during a hyperinsulinaemiceuglycaemic clamp, but urinary dopamine did not change. Thedata suggest that the relationship between urinary sodium excretionand tubular dopamine synthesis remains normal in early type1 diabetes mellitus both at baseline and during the antinatriuresisinduced by angiotensin II. The cause of the reduction in urinarydopamine during ANGII infusion is unclear, but is probably notmediated directly by changes in proximal tubular sodium transport.     

Effect of enalapril on proteinuria, phosphaturia, and calciuria in insulin-dependent diabetes

Elevated urinary calcium and phosphate excretion have been observed in children with insulin-dependent diabetes mellitus (IDDM). This may be related to a defect in tubular reabsorption. It is well known that converting enzyme inhibition decreases microalbuminuria and may prevent or retard diabetic nephropathy. We investigated whether enalapril also improves the defect in calcium and phosphate reabsorption. We studied 16 children and young adults (age 12–21 years) with IDDM and persistent microalbuminuria before and during 12 weeks of enalapril treatment. Before treatment microalbuminuria, urinary calcium excretion, and fractional tubular phosphorus reabsorption (TPR) were 153±53 μg/min, 5.5±0.9 mg/kg per day, and 71.4±3.6%, respectively. At the end of the 12th week, microalbuminuria had decreased to 20.3±7.9 μg/min and calcium excretion to 3.3±0.4 mg/kg per day (P<0.01), while the TPR increased to 80.1±3.8% (NS). The renal threshold phosphate concentration increased from 1.8±0.15 to 2.92±0.23 mg/dl (P<0.01). The fasting serum glucose and hemoglobin A_lc levels did not change significantly during the study. Systolic and diastolic blood pressures were 120.4±2.2/79.3±1.4 mm Hg and 110.5±1.8/ 71.3±0.9 mm Hg before and after 12 weeks, respectively. We conclude that enalapril treatment improves not only microalbuminuria but also abnormal calcium and phosphate excretion in microalbuminuric children with IDDM. Received February 10, 1997; received in revised form December 29, 1997; accepted January 2, 1998     

The effect of phenylephrine and norepinephrine in patients with chronic pulmonary hypertension*

In this study the effect of phenylephrine and norepinephrine for the treatment of systemic hypotension were evaluated in patients with chronic pulmonary hypertension. When systemic hypotension (systolic arterial pressure < 100 mmHg) occurred following induction of anaesthesia, either phenylephrine or norepinephrine were infused in a random manner to raise the systolic blood pressure by 30% and 50% above baseline values. Norepinephrine decreased the ratio of pulmonary arterial pressure to systemic blood pressure without a change in cardiac index. However, phenylephrine did not increase arterial blood pressure by more than 30% from baseline in one-third of patients and decreased cardiac index without a significant decrease in ratio of pulmonary arterial pressure to systemic blood pressure. These vasoconstrictors showed different systemic and pulmonary haemodynamic effects in patients with chronic pulmonary hypertension as compared to acute pulmonary hypertension. Norepinephrine was considered to be preferable to phenylephrine for the treatment of hypotension in patients with chronic pulmonary hypertension.     

Twenty-year prevalence of diabetes mellitus and hypertension in patients receiving shock-wave lithotripsy for urolithiasis

Study Type – Prevalence (retrospective cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Shockwave lithotripsy is a common and effective treatment method for kidney stones, but has been associated with long‐term complications, namely hypertension and diabetes. We compared the prevalence of these two disease in patients treated with lithotripsy to the background provincial population. Our analyses did not find an association between lithotripsy and the development of these diseases. Shockwave lithotripsy is an effective treatment modality for urolithiasis. The mechanism of stone communition during lithotripsy as well as the acute complications that occur following this treatment have been well described; however, the long‐term consequences of this procedure have not been clearly defined. Diabetes and hypertension have been associated with lithotripsy at 19 years follow‐up, though this relationship is controversial. This issue is further complicated by the interrelatedness of metabolic dysfunction and stone disease. Our data show that there is no association between lithotripsy and the development of either hypertension or diabetes. Patients treated for urolithiasis 20 years ago with shockwave lithotripsy were contacted, and their prevalence of diabetes and hypertension in these subjects was compared to the background population of British Columbia. The analysis also considered whether the properties of shockwaves delivered by the original Dornier HM‐3 versus a modified Dornier HM‐3 differentially affected the risk of our subjects developing these diseases. We did not find that lithotripsy, let alone the type of lithotriptor, was a risk factor for developing hypertension and diabetes. We postulate that the development of renal calculi in our subjects is more indicative of an overall metabolic syndrome where there is increasing evidence that patients with kidney stones get hypertension and diabetes and vice‐versa. The development of these diseases is not related to shockwave lithotripsy, but rather to a systemic metabolic dysfunction.

OBJECTIVES

? To compare the prevalence of hypertension and diabetes mellitus (DM) in patients treated with an unmodified HM‐3 lithotripter (USWL) and a second‐generation modified HM‐3 lithotripter (MSWL) 20 years ago at our Centre with that in the provincial population. ? To determine whether the type of lithotripter was differentially associated with the development of these sequelae.

PATIENTS AND METHODS

? Retrospective review of 727 patients at Vancouver General Hospital who underwent shock‐wave lithotripsy (SWL) between 1985 and 1989. ? Our study group was compared with Statistics Canada data describing the provincial prevalence of these diseases. ? Multivariate analysis was performed.

RESULTS

? The response rate was 37.3%. ? There was a greater proportion of overweight and obese individuals in the study group compared with the provincial average. ? In univariate analysis, lithotripsy with an unmodified HM‐3 (USWL) was associated with a higher rate of DM than the provincial rate, whereas lithotripsy with the modified HM‐3 (MSWL) was not. ? Hypertension was more prevalent in all lithotripsy subjects. ? On multivariate analysis the type of lithotripter was not associated with the development of either sequela.

CONCLUSIONS

? No association between lithotripsy and the development of either DM or hypertension in a multivariate analysis ? Metabolic syndrome may have elevated the prevalence of DM and hypertension observed in our subjects on univariate analysis, which is in keeping with the fact that our study population had statistically higher body mass indices than the provincial rate. ? Lithotripsy using the HM‐3 was not associated with increased DM or hypertension.     

糖尿病肾脏病患者尿白蛋白排泄率与骨代谢生化指标相关性分析

目的分析2型糖尿病患者尿白蛋白排泄率与骨代谢生化指标的相关性。方法选取2013年10月至2015年6月于重庆医科大学附属第一医院内分泌科住院的2型糖尿病患者302名。搜集其基本资料、骨代谢生化指标及骨密度等。按尿白蛋白排泄率(urinary albumin excretion rate,UAER)的水平将其分为正常白蛋白尿组(132名)、微量白蛋白尿组(101名)、大量白蛋白尿组(69名)。并作统计学分析。结果三组间骨密度(bone mineral density,BMD)比较差异无统计学意义,2型糖尿病患者25(OH)D3、1型前胶原氨基末端前肽(type I procollagen N-terminal propeptide,P1NP)在大量白蛋白尿组显著低于微量白蛋白尿组、正常白蛋白尿组(P0.05);随着UAER的升高,1型胶原羧基端肽β特殊序列(β-Carboxyl terminal peptide,β-CTX)逐渐升高、骨钙素(bone alkaline phosphatase,BGP)逐渐降低,大量白蛋白尿组、微量白蛋白尿组与正常白蛋白尿组比较差异有统计学意义(P0.05)。Spearman等级相关分析示P1NP、BGP、25(OH)D3与UAER呈负相关,β-CTX与UAER呈正相关。结论糖尿病肾脏病患者骨代谢生化指标的改变可能早于骨密度反映骨代谢异常。     

Effect of total knee arthroplasty on type II diabetes mellitus and hypertension: A prospective study

Context:

Advanced osteoarthritis of knee joint if bilateral, severely restricts patient mobility. This acts as an aggravating factor for pre existing comorbid elements of metabolical syndrome (MS) like Type II diabetes mellitus and hypertension as patients are unable to carry out therapeutic walks. Successfully implanted total knee arthroplasty (TKA) increases physical activity and enables to carry out therapeutic walks thus may help in better control of type II diabetes mellitus and hypertension. The objective of this prospective study was to find whether TKA for osteoarthritis knee had any effect to improve blood glucose levels and reduce blood pressure.

Materials and Methods:

A prospective study was done in which patients operated for tricompartmental osteoarthritis of knee with associated comorbidities like Type II diabetes mellitus or hypertension during a period of 2008 and 2009 were studied. One hundred and twenty patients were enrolled (55 diabetics, 65 hypertensives) who met our inclusion criteria. Preoperative knee society score, lower extremity activity scale fasting blood glucose level and systolic and diastolic blood pressure were compared with one year followup values. The KSS and LEAS scores were analysed by the Wilcoxon signed ranked test, while the fasting blood glucose (FBG) levels and systolic and diastolic blood pressure levels were analysed by paired ‘t’ test.

Results:

The reduction of systolic blood pressure by 8 mmHg (t = 5.6, P value < 0.05) and diastolic blood pressure by 6 mmHg (t = 7.6, P value < 0.05) was recorded which was statistically significant. However, no statistically significant effect on fasting blood glucose levels was observed (t = -0.77, P value = 0.442). KSS improved in DM from preoperative 29 to 86 and LEAS improved from 6.7 to 11.3.

Conclusions:

Authors are of the opinion that successful total knee replacement results in increased physical activity and reduces blood pressure (systolic and diastolic) in hypertensives. However, the same is not seen in blood glucose level. Increased physical activity and reduced dependence on NSAIDS postoperatively, may be contributing in reduction of systolic and diastolic blood pressure. Further studies in this aspect are necessary.     

Predictors of postoperative myocardial ischaemia The role of intercurrent arterial hypertension and other cardiovascular risk factors

One hundred and eighty-three patients were studied to examine the role of a number of risk factors in the development of silent ischaemia after general anaesthesia for general and vascular surgery. We collected evidence of cardiovascular risk factors using a binary questionnaire. The patients were monitored pre- and postoperatively using a Holter ECG monitor. Usable data were collected on 140 patients. Pre-operative silent myocardial ischaemia was found to be strongly associated with postoperative silent myocardial ischaemia (odds ratio: 10.8, 95% confidence intervals: 3.8–30.7). A history of hypertension, indicated by treatment with antihypertensive drugs, was associated with increased risk (odds ratio: 2.58, 95% confidence intervals: 1.12–5.96). A linear trend was found for risk associated with increasing admission systolic blood pressure (odds ratio: 1.20 for each 10-mmHg increase in systolic pressure, 95% confidence intervals: 1.01–1.42). An association between vascular surgery and postoperative silent myocardial ischaemia was also confirmed (odds ratio: 2.36, 95% confidence intervals: 1.1–5.1).     

Stimulatory effect of insulin on tubular sodium reabsorption in normotensive subjects with a positive family history of hypertension

BACKGROUND: Insulin resistance and hyperinsulinaemia has been suggestedas a pathogenetic mechanism in hypertension. METHODS: In this investigation the renal response to insulin was studiedin normotensive subjects with a positive family history of hypertensionin two generations (n = 14), in one weight-matched (n = 11)and one lean (n = 13) control group. During hyperinsulinaemia(euglycaemic hyperinsulinaemic clamp technique) we determinedrenal haemodynamics (clearances of ⁵¹Cr-EDTA and PAH) and urinarysodium excretion. Lithium clearance was used to estimate thesegmental tubular reabsorption of sodium. RESULTS: In subjects with a positive family history of hypertension,hyperinsulinaemia did not influence renal plasma flow (RPF)or glomerular filtration rate (GFR) but urinary sodium excretiondecreased by 50%. Estimated proximal tubular sodium reabsorptionwas unaffected by insulin while estimated distal fractionalsodium reabsorption increased, P<0.01. At the end of theclamp a low-dose infusion of angiotensin II (0.1 ng/kg per min)was superimposed. GFR and RPF then decreased significantly concomitantwith urinary excretion of sodium. In control subjects hyperinsulinaemia caused an unchanged GFRin both groups, increased RPF in the lean control group and15–25% reduction in sodium excretion. No alteration wasseen in estimated proximal tubular sodium reabsorption, butestimated distal tubular sodium reabsorption increased (P<0.05)in the lean control group. Angiotensin II elicited a furtherincrease in distal fractional tubular sodium reabsorption inboth control groups (P<0.05). CONCLUSIONS: In normotensive subjects with a positive family history of hypertension,in contrast to control subjects without such history, hyperinsulinaemiacaused a marked decrease in urinary sodium excretion in presenceof unchanged RPF and GFR indicating a renal tubular effect ofinsulin located at a distal site of the renal tubules. AngiotensinII caused further sodium retention, probably due to an effecton renal haemodynamics.     

Similar rate of progression in the predialysis phase in type I and type II diabetes mellitus

Progression of diabetic nephropathy from the stage of macroproteinuriawith near-normal renal function until start of dialysis wascompared in 16 patients with type I and 16 patients with typeII diabetes mellitus. The mean creatinine clearance at the beginningof the study was 89±13 ml/min/l.73 m² in patients withtype I and 81±6 ml/min/1.73 m in those with type II diabetes.Dialysis was started after a mean interval of 77(44–133)months, when creatinine clearance had decreased to 8 ±2 ml/min/1.73 m² in type I diabetic patients. The respectivefigures for type II diabetic patients were 81(40–124)months and 7±2 ml/min/1.73 m² The mean rate of decreasein creatinine clearance was 1.05 ± 0.45 ml/min/monthin type I and 0.91 ± 0.41 ml/min/month in type II diabetes.The mean rate of decrease was 1.46±0.30 ml/min/monthin type I diabetic patients with a systolic BP> 160 mmHgversus 0.80±0.42 ml/mm/month with <160 minHg (P>0.01).In the type II diabetics the respective figures were 1.38±0.40m1/min/monthversus 0.78 ± 0.15 ml/min/month (P>0.01). During theobservation period the prevalence of coronary heart diseaseincreased from 6 to 50% in type I and from 31 to 87% in typeII diabetes. In conclusion, the rate of progression of diabeticnephro pathy during the predialytic phase is similar in typeI and type II diabetes; BP adversely affects the rate of progressionto the same extent in both groups.     

护理干预对妊娠高血压综合征患者血压水平和分娩方式的影响

目的探讨护理干预对妊娠高血压综合征患者血压水平和分娩方式的影响。方法72例妊娠高血压综合征患者按随机数表法分为观察组和对照组各36例,观察组给予全面规范化护理干预,对照组采用常规护理,比较两组治疗后血压水平变化情况和对分娩方式的影响。结果观察组治疗后血压改善明显优于对照组（P〈0．05）,且观察组产妇自然分娩率明显高于对照组（P〈0．05）。结论对妊娠高血压综合征患者进行全面规范化的护理干预,可明显增强降压效果,提高产妇自然分娩率,值得临床推广应用。     

The challenge and response of podocytes to glomerular hypertension

Glomerular hypertension (ie, increased glomerular capillary pressure), has been shown to cause podocyte damage progressing to glomerulosclerosis in animal models. Increased glomerular capillary pressure results in an increase in wall tension that acts primarily as circumferential tensile stress on the capillary wall. The elastic properties of the glomerular basement membrane (GBM) and the elastic as well as contractile properties of the cytoskeleton of the endothelium and of podocyte foot processes resist circumferential tensile stress. Whether the contractile forces generated by podocytes are able to equal circumferential tensile stress to effectively counteract wall tension is an open question. Mechanical stress is transmitted from the GBM to the actin cytoskeleton of podocyte foot processes via cell-matrix contacts that contain mainly integrin α3β1 and a variety of linker, scaffolding, and signaling proteins, which are not well characterized in podocytes. We know from in vitro studies that podocytes are sensitive to stretch, however, the crucial mechanosensor in podocytes remains unclear. On the other hand, in vitro studies have shown that in stretched podocytes specific signaling cascades are activated, the synthesis and secretion of various hormones and their receptors are increased, cell-cycle arrest is reinforced, cell adhesion is altered through secretion of matricellular proteins and changes in integrin expression, and the actin cytoskeleton is reorganized in a way that stress fibers are lost. In summary, current evidence suggests that in glomerular hypertension podocytes primarily aim to maintain the delicate architecture of interdigitating foot processes in the face of an expanding GBM area.     

The relationship between the insertion/deletion polymorphism of the ACE gene and hypertension in Iranian patients with type 2 diabetes.

BACKGROUND: Observations on the association between the ACE gene polymorphism and hypertension have been inconsistent, which might be due to ethnic and geographical variations. Moreover, the relationship between insertion/deletion (I/D) polymorphism and hypertension in the diabetic population has not been sufficiently studied. The aim of this study was to evaluate for the first time the possible association between I/D polymorphism and hypertension in an Iranian diabetic adult population. METHODS: A total of 82 consecutive patients with type 2 diabetes and hypertension (Group A) and 87 patients with type 2 diabetes but without hypertension (Group B) were included. Patients who had a history of hypertension before the onset of diabetes and those with findings suggesting secondary hypertension were excluded. The following variables were determined for each patient: age, sex, body mass index (BMI), diabetes duration and the drugs used, history of coronary artery disease and its complications, blood pressure (systolic and diastolic), fasting blood sugar (FBS), haemoglobin A1c (HbA1c), total cholesterol (Chol), low-density lipoproteins (LDL), high-density lipoproteins (HDL), triglycerides (TG), plasma creatinine (Crt) and 24 h urine albumin excretion. Polymerase chain reaction (PCR) was used to detect the I/D alleles. Univariate (chi-squared and t-test) and multivariate (multivariate binary logistic regression with adjusted odds ratios) analyses were applied to determine the association between I/D polymorphism (with genotype II as reference) and hypertension. P<0.05 was considered statistically significant. RESULTS: In univariate analysis, the groups were statistically similar in all variables except for diabetes duration (156.05+/-73.54 months in Group A vs 121.74+/-65.53 months in Group B; P=0.002), Crt (1.04+/-0.25 mg/dl in Group A vs 0.93+/-0.23 mg/dl in Group B; P=0.003), albuminuria (486.25+/-484.60 mg/d in Group A vs 316.50+/-459.56 mg/d in Group B; P=0.021) and the frequency of DD genotype (27 cases in Group A vs 11 cases in Group B; P=0.026). Multivariate logistic regression (using age, sex and BMI as clinically significant variables and diabetes duration, Crt, albuminuria and genotype as statistically significant variables) was then used to determine independent associations and adjusted odds ratios (OR). The DD genotype was the strongest independent predictor of hypertension [P=0.029, OR=3.122, 95% confidence interval (CI)=1.127-8.647], followed by log (albuminuria) (P=0.042, OR=1.183, 95% CI=1.006-1.391). Considering albuminuria as a categorical variable did not change the results significantly. CONCLUSION: The DD polymorphism in the ACE gene is independently associated with hypertension in the diabetic population.     

Relation of glycaemic control and hypertension to progression of glomerular lesions in non-insulin dependent diabetes mellitus

Summary: We investigated the influence of glycaemic control and hypertension on the progression of renal structural changes in 18 patients with non-insulin dependent diabetes mellitus (NIDDM) who had undergone sequential renal biopsies. Renal biopsies were performed after median interval of 6.0 years (range 2-11 years). the severity of glomerular diffuse lesions was graded on a 5-point scale according to Gellman's criteria. Subjects were divided into two groups: (i) patients who showed progression of glomerular diffuse lesions ( n = 12); and (ii) patients who showed no change in histological grade ( n = 6). Mean arterial blood pressure was significantly higher in group 1. There was no significant difference in the HbA_1c between the two groups. These findings suggest that the mean arterial blood pressure is closely related to the progression of glomerular morphological changes regardless of the status of glycaemic control.     

The effect of hypertension and diabetes on the degree of renal function deterioration after unilateral nephrectomy

Study Type – Prognosis (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Hypertension and diabetes have long been identified as both initiating and progressing factors in chronic kidney disease, as well as predictors of long‐term renal impairment in individuals undergoing nephrectomy. Radical nephrectomy itself is an independent risk factor for chronic kidney disease and its associated increased risk of morbid cardiac events and death. These data have been used to support the argument for greater use of partial nephrectomy when dealing with small renal masses. Whilst in the past it has always been seen as intuitive that patients with hypertension and diabetes would have worse renal function after removal of a kidney for malignancy, the present study is the first to quantify this fact. This information could be used to identify those patients who would benefit from early intervention to delay the progression of chronic kidney disease, as well as those for whom partial nephrectomy might be a more appropriate surgical option.

OBJECTIVE

• ? To quantify the effect of hypertension and diabetes – which have been identified as both initiating and progressing factors in chronic kidney disease (CKD), as well as predictors of long‐term renal impairment in patients undergoing nephrectomy – on renal function after unilateral nephrectomy for malignancy.

PATIENTS AND METHODS

• ? A retrospective analysis was carried out of 80 unilateral nephrectomies performed at the Wagga Wagga Base Hospital, Calvary Private Hospital and Austin Hospital from January 2007 to December 2009.
• ? Prognostic variables were patient age, sex and the presence of hypertension or diabetes.
• ? The percentage reduction in glomerular filtration rate (GFR) after nephrectomy was measured and compared between variables using a two‐sample Student’s t‐test.

RESULTS

• ? All patients who had diabetes also had hypertension.
• ? Of the 80 patients, 22 (27.5%) fulfilled the criteria for CKD with a preoperative GFR < 60 mL/min.
• ? Patients with hypertension and diabetes had a significantly greater percentage reduction in postoperative GFR (36 ± 2%) than those who had neither risk factor (23 ± 2%, P < 0.003). A similar finding was observed for patients with hypertension alone (32 ± 1%, P < 0.009).
• ? The difference in postoperative GFR reduction between diabetics and those with hypertension alone was not statistically significant (P= 0.205).
• ? The differential reduction in GFR in patients with CKD risk factors persisted at 3–12 months follow‐up.

CONCLUSIONS

• ? An increased percentage reduction in GFR is seen in patients with hypertension and diabetes undergoing unilateral nephrectomy for malignancy.
• ? These data could be used to identify those patients who would benefit from early referral and subsequent intervention to delay the progression of CKD, as well as those for whom nephron‐sparing surgery might be a more appropriate surgical option.

     

Health literacy and the perception of risk in a breast cancer family history clinic

Background

Informed consent is an essential component of medical practice, and especially so in procedural based specialties which entail varying degrees of risk. Breast cancer is one of the most common cancers in women, and as such is the focus of extensive research and significant media attention. Despite this, considerable misperception exists regarding the risk of developing breast cancer.

The effects of ethinylestradiol,a glucose diet and streptozotocin induced diabetes mellitus on gallstone formation and biliary lipid composition in the hamster

Possible risk factors for gallstone formation were examined and the concentrations of biliary lipids and each bile acid in the hepatic and gallbladder bile of hamsters were quantified. Forty female golden Syrian hamsters were divided into 4 groups according to diet; Group I, given control chow, Group II, given an ethinylestradiol and cholesterol supplemented diet, Group III, given a glucose rich diet without induced diabetes mellitus, and Group IV, given a glucose rich diet with diabetes mellitus induced by streptozotocin injection. The formation of cholesterol crystals but not gallstones was induced in Group II associated with a significantly decreased total bile acid concentration in the gallbladder bile but not in the hepatic bile. The formation of cholesterol gallstones and crystals with significantly higher concentrations of cholesterol and phospholipid was observed in Group III, while neither the formation of gallstones nor lithogenicity was enhanced by diabetes mellitus. However, a quite different lithogenicity was evident between the hepatic and gallbladder bile of the Group IV animals. These results suggest that neither the consumption of oral contraceptives nor diabetes mellitus induces gallstone formation, but that these factors can be responsible for dysfunction of the gallbladder.