Thyroid hormones (TH) are essential for an adequate growth and development of the kidney. Conversely, the kidney is not only an organ for metabolism and elimination of TH, but also a target organ of some of the iodothyronines' actions. Thyroid dysfunction causes remarkable changes in glomerular and tubular functions and electrolyte and water homeostasis. Hypothyroidism is accompanied by a decrease in glomerular filtration, hyponatremia, and an alteration of the ability for water excretion. Excessive levels of TH generate an increase in glomerular filtration rate and renal plasma flow. Renal disease, in turn, leads to significant changes in thyroid function. The association of different types of glomerulopathies with both hyper- and hypofunction of the thyroid has been reported. Less frequently, tubulointerstitial disease has been associated with functional thyroid disorders. Nephrotic syndrome is accompanied by changes in the concentrations of TH due primarily to loss of protein in the urine. Acute kidney injury and chronic kidney disease are accompanied by notable effects on the hypothalamus-pituitary-thyroid axis. The secretion of pituitary thyrotropin (TSH) is impaired in uremia. Contrary to other non-thyroidal chronic disease, in uraemic patients it is not unusual to observe the sick euthyroid syndrome with low serum triodothyronine (T(3)) without elevation of reverse T(3) (rT(3)). Some authors have reported associations between thyroid cancer and kidney tumors and each of these organs can develop metastases into the other. Finally, data from recent research suggest that TH, especially T(3), can be considered as a marker for survival in patients with kidney disease.

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Thyroid dysfunction and kidney disease

OBJECTIVE:To investigate whether effects on food intake are seen in obese subjects receiving exogenous administration of ghrelin.DESIGN:Randomised, double-blind, placebo-controlled study of intravenous ghrelin at doses 1 pmol/kg/min and 5 pmol/kg/min.SUBJECTS:In all, 12 healthy lean subjects (mean body mass index (BMI) 20.5±0.17 kg/m2) and 12 healthy overweight and obese subjects (mean BMI 31.9±1.02 kg/m2).MEASUREMENTS:Food intake, appetite and palatability of food, ghrelin and other obesity-related hormones, growth hormone.RESULTS:Low-dose infusion of ghrelin increased ad libitum energy intake at a buffet meal in the obese group only (mean increase 36.6±9.4%, P<0.01.) High-dose ghrelin infusion increased energy intake in both groups (mean increase 20.1±10.6% in the lean and 70.1±15.5% in the obese, P<0.01 in both cases.) Ghrelin infusion increased palatability of food in the obese group.CONCLUSION:Ghrelin increases food intake in obese as well as lean subjects. Obese people are sensitive to the appetite-stimulating effects of ghrelin and inhibition of circulating ghrelin may be a useful therapeutic target in the treatment of obesity.

Ghrelin increases food intake in obese as well as lean subjects

http://zielinskifam.com/lit/neuro/neurologic%20complications%20in%20Uremia.pdf

Neurological complications in renal failure: a review.

Objective To develop evidence-based clinical practice guidelines for interventional techniques in the diagnosis and treatment of chronic spinal pain. Methodology Systematic assessment of the literature. Evidence I. Lumbar Spine • The evidence for accuracy of diagnostic selective nerve root blocks is limited; whereas for lumbar provocation discography, it is fair. • The evidence for diagnostic lumbar facet joint nerve blocks and diagnostic sacroiliac intraarticular injections is good with 75% to 100% pain relief as criterion standard with controlled local anesthetic or placebo blocks. • The evidence is good in managing disc herniation or radiculitis for caudal, interlaminar, and transforaminal epidural injections; fair for axial or discogenic pain without disc herniation, radiculitis or facet joint pain with caudal, and interlaminar epidural injections, and limited for transforaminal epidural injections; fair for spinal stenosis with caudal, interlaminar, and transforaminal epidural injections; and fair for post surgery syndrome with caudal epidural injections and limited with transforaminal epidural injections. • The evidence for therapeutic facet joint interventions is good for conventional radiofrequency, limited for pulsed radiofrequency, fair to good for lumbar facet joint nerve blocks, and limited for intraarticular injections. • For sacroiliac joint interventions, the evidence for cooled radiofrequency neurotomy is fair; limited for intraarticular injections and periarticular injections; and limited for both pulsed radiofrequency and conventional radiofrequency neurotomy. • For lumbar percutaneous adhesiolysis, the evidence is fair in managing chronic low back and lower extremity pain secondary to post surgery syndrome and spinal stenosis. • For intradiscal procedures, the evidence for intradiscal electrothermal therapy (IDET) and biaculoplasty is limited to fair and is limited for discTRODE. • For percutaneous disc decompression, the evidence is limited for automated percutaneous lumbar discectomy (APLD), percutaneous lumbar laser disc decompression, and Dekompressor; and limited to fair for nucleoplasty for which the Centers for Medicare and Medicaid Services (CMS) has issued a noncoverage decision. II. Cervical Spine • The evidence for cervical provocation discography is limited; whereas the evidence for diagnostic cervical facet joint nerve blocks is good with a criterion standard of 75% or greater relief with controlled diagnostic blocks. • The evidence is good for cervical interlaminar epidural injections for cervical disc herniation or radiculitis; fair for axial or discogenic pain, spinal stenosis, and post cervical surgery syndrome. • The evidence for therapeutic cervical facet joint interventions is fair for conventional cervical radiofrequency neurotomy and cervical medial branch blocks, and limited for cervical intraarticular injections. III. Thoracic Spine • The evidence is limited for thoracic provocation discography and is good for diagnostic accuracy of thoracic facet joint nerve blocks with a criterion standard of at least 75% pain relief with controlled diagnostic blocks. • The evidence is fair for thoracic epidural injections in managing thoracic pain. • The evidence for therapeutic thoracic facet joint nerve blocks is fair, limited for radiofrequency neurotomy, and not available for thoracic intraarticular injections. IV. Implantables • The evidence is fair for spinal cord stimulation (SCS) in managing patients with failed back surgery syndrome (FBSS) and limited for implantable intrathecal drug administration systems. V. ANTICOAGULATION • There is good evidence for risk of thromboembolic phenomenon in patients with antithrombotic therapy if discontinued, spontaneous epidural hematomas with or without traumatic injury in patients with or without anticoagulant therapy to discontinue or normalize INR with warfarin therapy, and the lack of necessity of discontinuation of nonsteroidal anti-inflammatory drugs (NSAIDs), including low dose aspirin prior to performing interventional techniques. • There is fair evidence with excessive bleeding, including epidural hematoma formation with interventional techniques when antithrombotic therapy is continued, the risk of higher thromboembolic phenomenon than epidural hematomas with discontinuation of antiplatelet therapy prior to interventional techniques and to continue phosphodiesterase inhibitors (dipyridamole, cilostazol, and Aggrenox). • There is limited evidence to discontinue antiplatelet therapy with platelet aggregation inhibitors to avoid bleeding and epidural hematomas and/or to continue antiplatelet therapy (clopidogrel, ticlopidine, prasugrel) during interventional techniques to avoid cerebrovascular and cardiovascular thromboembolic fatalities. • There is limited evidence in reference to newer antithrombotic agents dabigatran (Pradaxa) and rivaroxan (Xarelto) to discontinue to avoid bleeding and epidural hematomas and are continued during interventional techniques to avoid cerebrovascular and cardiovascular thromboembolic events. Conclusions Evidence is fair to good for 62% of diagnostic and 52% of therapeutic interventions assessed. Disclaimer The authors are solely responsible for the content of this article. No statement on this article should be construed as an official position of ASIPP. The guidelines do not represent "standard of care."

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An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations.

Background: Careful review of published evidence has led to the postulate that the degree of lumbar lordosis may possibly influence the development and progression of spinal osteoarthritis, just as misalignment does in other joints. Spinal degeneration can ensue from the asymmetrical distribution of loads. The resultant lesions lead to a domino- like breakdown of the normal morphology, degenerative instability and deviation from the correct configuration. The aim of this study is to investigate whether a relationship exists between the sagittal alignment of the lumbar spine, as it is expressed by lordosis, and the presence of radiographic osteoarthritis. Methods: 112 female subjects, aged 40-72 years, were examined in the Outpatients Department of the Orthopedics’ Clinic, University Hospital of Heraklion, Crete. Lumbar radiographs were examined on two separate occasions, independently, by two of the authors for the presence of osteoarthritis. Lordosis was measured from the top of L1 to the bottom of L5 as well as from the top of L1 to the top of S1. Furthermore, the angle between the bottom of L5 to the top of S1 was also measured. Results and discussion: 49 women were diagnosed with radiographic osteoarthritis of the lumbar spine, while 63 women had no evidence of osteoarthritis and served as controls. The two groups were matched for age and body build, as it is expressed by BMI. No statistically significant differences were found in the lordotic angles between the two groups Conclusions: There is no difference in lordosis between those affected with lumbar spine osteoarthritis and those who are disease free. It appears that osteoarthritis is not associated with the degree of lumbar lordosis.

/pdf/the-association-of-spinal-osteoarthritis-with-lumbar-2tel2soeoi.pdf

The association of spinal osteoarthritis with lumbar lordosis

Lyme neuroborreliosis (LNB) is a rare cause of vasculitis and stroke. It may manifest as subarachnoid hemorrhage, intracerebral hemorrhage, and most often ischemic stroke due to cerebral vasculitis. The vast majority of reported cases have been described by European authors. A high index of suspicion is required in patients who live or have traveled to areas with high prevalence of tick-borne diseases, and in the case of stroke-like symptoms of unknown cause in patients without cardiovascular risk factors. In this review, we also present four illustrative cases of vasculitis and stroke-like manifestations of LNB.

Vasculitis and stroke due to Lyme neuroborreliosis – a review

Distribution pattern of CART-containing neurons and cells in the human pancreas.

The main diagnostic method for renal graft dysfunction is color Doppler ultrasound with the use of spectrae evaluation of blood flow within the main and intrarenal arteries. Ultrasound with contrast medium (US-CM) enhances the possibilities of this tool. The aim of this study was to evaluate the efficacy of US-CM to assess renal graft perfusion among 18 kidney allograft recipients at 5 to 10 days after transplantation. Patients underwent pulse inversion sonography of the graft during intravenous injections of 2.4 mL SonoVue (Bracco-Altana, Italy). Images were quantitatively assessed using computer software to compare the time to peak contrast enhancement effect in the renal cortex and renal pyramids. The results were compared to Doppler ultrasonography of the renal arteries and estimated glomerular filtration rate (eGFR; Modification of Diet in Renal Disease [MDRD]). A correlation was observed between eGFR and blood flow parameters within the renal arteries, as well between the flow time of contrast medium from the artery within the renal hilus to the renal cortex. Increased eGFR correlated with subsequent improvement in graft function (r = -.806; P = .001), and resistive index (RI) of the renal artery was inversely related to subsequent delayed graft function (r = .544; P = .029). Negative correlations were observed between eGFR and renal artery RI, as well as between eGFR and time from renal artery contrast to maximal contrast enhancement of the renal pyramids. A negative correlation was found as well between eGFR and time difference of contrast enhancement of the cortex and pyramids. In conclusion, US-CM enhanced the efficacy of ultrasound diagnostics of the renal graft and may be used as a predictor of graft function in the early posttransplantation period.

Renal parenchyma perfusion spectrum and resistive index (RI) in ultrasound examinations with contrast medium in the early period after kidney transplantation.

BACKGROUND The x-ray examination is one of the fundamental diagnostic modalities in patients with low-back-pain. The aim of study was to establish relation between radiological findings and herniation type and its localization. As well, we looked for relation between radiological findings and progression of disc degeneration. MATERIAL/METHODS The study enrolled 187 individuals operated due to lumbar disc herniation. In each case the x-ray examination of lumbar spine was performed. Herniation was classified as protrusion, prolapse or disc sequestration. According to localization, herniation was defined as central, lateral or intermediate. Removed discs were histologically evaluated to determine degeneration symptoms. The radiological picture was related to the degeneration of the intervertebral discs. RESULTS The statistical analysis revealed the only one relation -between traction osteophytes and herniation classified as disc prolapse (p<0.05). We found no relations between other radiological findings (narrow intervertebral space, diminished lordosis, scoliosis) and herniation and its localization within the spinal canal. Also there is no relation between disc degeneration and radiological findings. CONCLUSIONS Classic x-ray examination presents low value in diagnostics of lumbar disc degeneration and its herniation. There is no relation between radiological picture and intensity of degenerative changes within the lumbar discs.

The radiological symptoms of lumbar disc herniation and degenerative changes of the lumbar intervertebral discs

Background Renal allograft survival depends on a number of factors, however, no reliable simple parameter has been shown to predict long-term outcome after transplantation. Ultrasound is recognized and relatively inexpensive, providing information about renal location, contour, and size. Doppler ultrasonography shows kidney morphology and hemodynamics. The aim of this study was the evaluation of whether Doppler ultrasound of renal arteries performed in the early stage after transplantation was a valuable predictor for long-term-outcomes. Material and Methods The study included 17 female and 24 male patients, aged 17–69 years with stable graft function. The Doppler ultrasound of renal flow was done on the 1st and 3rd day after transplantaion, and estimated glomerular filtration rate (eGFR) on the 20th day. The measured indices were as follows: maximum blood flow velocity (Vmax), minimum blood flow velocity (Vmin), resistive index (RI), and pulsatile index (PI). The creatinine concentration was evaluated, and eGFR calculated. Results Mean renal and intrarenal artery RI increased to day 3 after transplantation, and then reduced. The mean renal and intrarenal Vmax at day 3 correlated positively with eGFR (r = 0.38; P = .015); (r = 0.45; P = .003, respectively). Mean renal and intrarenal Vmin correlated positively with eGFR (r = 0.50; P = .001; r = 0.41; P = .008, respectively). The mean renal and intrarenal Vmax and Vmin on day 1 did not correlate with eGFR. Conclusions Early Doppler Ultrasonography of renal graft hemodynamics may be a valuable predictor of graft survival and long-term outcomes. Blood flow velocity within renal arteries seemed to be an important factor.

Wojciech Łebkowski

Papers

Vasculitis and stroke due to Lyme neuroborreliosis – a review

Distribution pattern of CART-containing neurons and cells in the human pancreas.

Renal parenchyma perfusion spectrum and resistive index (RI) in ultrasound examinations with contrast medium in the early period after kidney transplantation.

The radiological symptoms of lumbar disc herniation and degenerative changes of the lumbar intervertebral discs

The Predictive Value of Arterial Renal Blood Flow Parameters in Renal Graft Survival