https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(13)60687-X.pdf

Chronic kidney disease: global dimension and perspectives

ContextThe long-term risk for developing hypertension is best described by
the lifetime risk statistic. The lifetime risk for hypertension and trends
in this risk over time are unknown.ObjectivesTo estimate the residual lifetime risk for hypertension in older US
adults and to evaluate temporal trends in this risk.Design, Setting, and ParticipantsCommunity-based prospective cohort study of 1298 participants from the
Framingham Heart Study who were aged 55 to 65 years and free of hypertension
at baseline (1976-1998).Main Outcome MeasuresResidual lifetime risk (lifetime cumulative incidence not adjusted for
competing causes of mortality) for hypertension, defined as blood pressure
of 140/90 mm Hg or greater or use of antihypertensive medications.ResultsThe residual lifetime risks for developing hypertension and stage 1
high blood pressure or higher (≥140/90 mm Hg regardless of treatment) were
90% in both 55- and 65-year-old participants. The lifetime probability of
receiving antihypertensive medication was 60%. The risk for hypertension remained
unchanged for women, but it was approximately 60% higher for men in the contemporary
1976-1998 period compared with an earlier 1952-1975 period. In contrast, the
residual lifetime risk for stage 2 high blood pressure or higher (≥160/100
mm Hg regardless of treatment) was considerably lower in both sexes in the
recent period (35%-57% in 1952-1975 vs 35%-44% in 1976-1998), likely due to
a marked increase in treatment of individuals with substantially elevated
blood pressure.ConclusionThe residual lifetime risk for hypertension for middle-aged and elderly
individuals is 90%, indicating a huge public health burden. Although the decline
in lifetime risk for stage 2 high blood pressure or higher represents a major
achievement, efforts should be directed at the primary prevention of hypertension.

https://jamanetwork.com/journals/jama/articlepdf/194679/joc11272.pdf

Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study.

Objective  To develop a practical evidence based list of clinical risk factors that can be assessed by a clinician at ≤16 weeks’ gestation to estimate a woman’s risk of pre-eclampsia. Design  Systematic review and meta-analysis of cohort studies. Data sources  PubMed and Embase databases, 2000-15. Eligibility criteria for selecting studies  Cohort studies with ≥1000 participants that evaluated the risk of pre-eclampsia in relation to a common and generally accepted clinical risk factor assessed at ≤16 weeks’ gestation. Data extraction  Two independent reviewers extracted data from included studies. A pooled event rate and pooled relative risk for pre-eclampsia were calculated for each of 14 risk factors. Results  There were 25 356 688 pregnancies among 92 studies. The pooled relative risk for each risk factor significantly exceeded 1.0, except for prior intrauterine growth restriction. Women with antiphospholipid antibody syndrome had the highest pooled rate of pre-eclampsia (17.3%, 95% confidence interval 6.8% to 31.4%). Those with prior pre-eclampsia had the greatest pooled relative risk (8.4, 7.1 to 9.9). Chronic hypertension ranked second, both in terms of its pooled rate (16.0%, 12.6% to 19.7%) and pooled relative risk (5.1, 4.0 to 6.5) of pre-eclampsia. Pregestational diabetes (pooled rate 11.0%, 8.4% to 13.8%; pooled relative risk 3.7, 3.1 to 4.3), prepregnancy body mass index (BMI) >30 (7.1%, 6.1% to 8.2%; 2.8, 2.6 to 3.1), and use of assisted reproductive technology (6.2%, 4.7% to 7.9%; 1.8, 1.6 to 2.1) were other prominent risk factors. Conclusions  There are several practical clinical risk factors that, either alone or in combination, might identify women in early pregnancy who are at “high risk” of pre-eclampsia. These data can inform the generation of a clinical prediction model for pre-eclampsia and the use of aspirin prophylaxis in pregnancy.

https://www.bmj.com/content/bmj/353/bmj.i1753.full.pdf

Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies

Selenium is an essential micronutrient that plays a crucial role in development and a wide variety of physiological processes including effect immune responses The immune system relies on adequate dietary selenium intake and this nutrient exerts its biological effects mostly through its incorporation into selenoproteins The selenoproteome contains 25 members in humans that exhibit a wide variety of functions The development of high-throughput omic approaches and novel bioinformatics tools has led to new insights regarding the effects of selenium and selenoproteins in human immuno-biology Equally important are the innovative experimental systems that have emerged to interrogate molecular mechanisms underlying those effects This review presents a summary of the current understanding of the role of selenium and selenoproteins in regulating immune cell functions and how dysregulation of these processes may lead to inflammation or immune-related diseases

/pdf/selenium-selenoproteins-and-immunity-2fjtzviqkh.pdf

Selenium, Selenoproteins, and Immunity

Naturally Occurring Human Urinary Peptides for Use in Diagnosis of Chronic Kidney Disease

Background Chronic kidney disease (CKD) is increasing worldwide at an annual growth rate of 8%. Regional differences exist in the epidemiology of the condition, and non-Whites are more affected. Methods An English-language literature search using Medline (January 1984-October 2003) was done to assess research/review articles on burden and prevention of CKD. Particular attention was paid to epidemiology and prevention of chronic kidney diseases. Results The prevalence of CKD is higher in developing countries than in the developed world. The most common causes of CKD in the developing countries are chronic glomerulonephritis and systemic hypertension, diabetic nephropathy being the most common cause in Europe, the United States, and Japan. Factors contributing to the regional differences in the etiology and prevalence of CKD are race and ethnicity, genetic predisposition, increasing prevalence of type 2 diabetes, mortality caused by other disease, obesity, and possibly cigarette smoking. The control of hypertension, dyslipidemia, proteinuria, obesity, avoidance of low birth weight, smoking, and preventing ingesting of heavy metals such as lead are intervention strategies that retard or prevent progression of renal diseases. The magnitude of the existing burden of illness caused by renal failure, the projections for increasing incidence of CKD, and the limitations of our existing treatments for renal insufficiency all point to the need for clinical and population-based interventions aimed at prevention of CKD. Conclusions A comprehensive health education campaign and screening of the general populace are needed in order to detect chronic kidney disease early. These measures will ensure appropriate and timely institution of proven measures to halt or reduce progression of CKD.

The global burden of chronic kidney disease and the way forward.

The earliest clinical evidence of diabetic nephropathy is microalbuminuria. Progression from microalbuminuria to overt nephropathy occurs in 20-40% within a 10-year period with approximately 20% of these patients progressing to end-stage renal disease. End-stage renal disease develops in 50% of type-1 diabetes patients with overt nephropathy within 10 years and in more than 75% by 20 years in the absence of treatment. In type-2 diabetes, a greater proportion of patients have microalbuminuria and overt nephropathy at or shortly after diagnosis of diabetes. The incidence of diabetes is increasing worldwide, with subsequent increase in the incidence of diabetic nephropathy. The risk factors identified in the development of DN from longitudinal and cross-sectional studies include race, genetic susceptibility, hypertension, hyperglycemia, hyperfiltration, smoking, advanced age, male sex, and high-protein diet. Treatment interventions in diabetic nephropathy include glycemic control, treatment of hypertension, hyperlipidemia, cessation of smoking, protein restriction, and renal replacement therapy. Multifactorial approach includes combined therapy targeting hyperglycemia, hypertension, microalbuminuria, and dyslipidemia.

Diabetic nephropathy--a review of the natural history, burden, risk factors and treatment.

https://www.ackdjournal.org/article/S1548-5595(10)00038-8/pdf

Burden of chronic kidney disease: an international perspective.

:
Aim: The development of lupus nephritis (LN) is associated with increased morbidity and mortality. In view of scarce data from South Africa on factors affecting renal outcome in LN, the authors' experience was reviewed to identify predictors of poor renal outcome.

Methods:  This is a retrospective review of 105 patients with biopsy-proven LN under our care from January 1995 to December 2007.

Results:  Forty-three (41.0%) patients reached the composite end-point of persistent doubling of the serum creatinine over the baseline value, development of end-stage renal disease (ESRD) or death during a mean follow-up period of 51.1 months (range 1–137 months). Baseline factors associated with the composite end-point included presence of systemic hypertension (P = 0.016), mean systolic blood pressure (SBP) (P = 0.004), mean diastolic blood pressure (DBP) (P = 0.001), mean serum creatinine (P = 0.001), estimated glomerular filtration rate (eGFR) (P = 0.003) and diffuse proliferative glomerulonephritis (World Health Organization class IV) (P = 0.024). Interstitial inflammation (P = 0.049), failure of remission in the first year following therapy (P < 0.001), the mean SBP on follow up (P < 0.001) and mean DBP on follow up (P < 0.001) were also associated with composite end-point. On multivariate analysis, baseline serum creatinine, non-remission following therapy (P = 0.038) and mean SBP on follow up (P = 0.016) were predictors of poor renal outcome.

Conclusion:  Baseline serum creatinine, failure of remission in the first year and mean SBP were predictors of poor renal outcome.

Predictors of poor renal outcome in patients with biopsy-proven lupus nephritis.

INTRODUCTION: Few reports from Nigeria have examined the quality of life (QOL) of people living with HIV/AIDS (PLWHA) despite the fact that Nigeria has the second largest number of PLWHA in the world. This study evaluated the QOL of Nigerians living with HIV/AIDS using the World Health Organization Quality of Life Questionnaire for HIV-Brief Version (WHOQOL-BREF) instrument and assessed the impact of demographic laboratory and disease-related variables on QOL. METHODS: This cross-sectional study involved 491 consecutive PLWHA aged >/= 18 years attending the dedicated clinic to PLWHA in South-west Nigeria. RESULTS: The lowest mean QOL scores were recorded in the environment and social domains. Participants aged >/= 40 years had better QOL in the environment (p = 0.039) and spirituality (p = 0.033) domains and those in relationships had better QOL in the social relationship domain (p = 0.002). Subjects with no or primary education and those who rated their health status as good gave significantly higher ratings in all QOL domains. Participants with AIDS had significant lower QOL in the level of independence domain (p = 0.018) and those with CD4 count >/= 350 cells /mm3 had better QOL scores in the physical psychological and level of independence domains. Subjects without tuberculosis co-infection and those on antiretroviral therapy (ART) reported significantly better QOL in the physical psychological level of independence and spirituality domains. CONCLUSION: Marital relationship absence of tuberculosis CD4 count >/= 350 cells /mm3 and use of ART positively impacted QOL of our patients.

Olugbenga E. Ayodele

Papers

The global burden of chronic kidney disease and the way forward.

Diabetic nephropathy--a review of the natural history, burden, risk factors and treatment.

Burden of chronic kidney disease: an international perspective.

Predictors of poor renal outcome in patients with biopsy-proven lupus nephritis.

Quality of life of Nigerians living with human immunodeficiency virus