Medical therapy to facilitate urinary stone passage : a meta-analysis. Commentary

The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients.We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m2 of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m2 with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to <10 ml per minute per 1.73 m2, a sustained decrease in eGFR of ≥40% from baseline, or death from renal causes) or death from cardiovascular causes.A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P<0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P = 0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups.Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo. (Funded by Boehringer Ingelheim and others; EMPA-KIDNEY ClinicalTrials.gov number, NCT03594110; EudraCT number, 2017-002971-24.). 

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Empagliflozin in Patients with Chronic Kidney Disease

Metabolic syndrome (MetS) forms a cluster of metabolic dysregulations including insulin resistance, atherogenic dyslipidemia, central obesity, and hypertension. The pathogenesis of MetS encompasses multiple genetic and acquired entities that fall under the umbrella of insulin resistance and chronic low-grade inflammation. If left untreated, MetS is significantly associated with an increased risk of developing diabetes and cardiovascular diseases (CVDs). Given that CVDs constitute by far the leading cause of morbidity and mortality worldwide, it has become essential to investigate the role played by MetS in this context to reduce the heavy burden of the disease. As such, and while MetS relatively constitutes a novel clinical entity, the extent of research about the disease has been exponentially growing in the past few decades. However, many aspects of this clinical entity are still not completely understood, and many questions remain unanswered to date. In this review, we provide a historical background and highlight the epidemiology of MetS. We also discuss the current and latest knowledge about the histopathology and pathophysiology of the disease. Finally, we summarize the most recent updates about the management and the prevention of this clinical syndrome.

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Metabolic Syndrome: Updates on Pathophysiology and Management in 2021

White adipose tissue, once regarded as morphologically and functionally bland, is now recognized to be dynamic, plastic and heterogenous, and is involved in a wide array of biological processes including energy homeostasis, glucose and lipid handling, blood pressure control and host defence1. High-fat feeding and other metabolic stressors cause marked changes in adipose morphology, physiology and cellular composition1, and alterations in adiposity are associated with insulin resistance, dyslipidemia and type 2 diabetes2. Here we provide detailed cellular atlases of human and mouse subcutaneous and visceral white fat at single-cell resolution across a range of body weight. We identify subpopulations of adipocytes, adipose stem and progenitor cells, vascular and immune cells and demonstrate commonalities and differences across species and dietary conditions. We link specific cell types to increased risk of metabolic disease and provide an initial blueprint for a comprehensive set of interactions between individual cell types in the adipose niche in leanness and obesity. These data comprise an extensive resource for the exploration of genes, traits and cell types in the function of white adipose tissue across species, depots and nutritional conditions. 

A single-cell atlas of human and mouse white adipose tissue

Clinical laboratory diagnostics : use and assessment ofclinical laboratory results

Background/Aims: Magnesium is an essential mineral for many metabolic functions. There is very little information on the effect of magnesium supplementation on me

/pdf/magnesium-replacement-improves-the-metabolic-profile-in-3li2qnmub4.pdf

Magnesium Replacement Improves the Metabolic Profile in Obese and Pre-Diabetic Patients with Mild-to-Moderate Chronic Kidney Disease: A 3-Month, Randomised, Double-Blind, Placebo-Controlled Study

BACKGROUND Erectile dysfunction (ED) is common in older men with chronic kidney disease. Magnesium is essential for metabolism of nitric oxide which helps in penile erection. There is little information available about the influence of serum magnesium on ED. The aim of the study was to assess the influence of hypomagnesemia on ED in elderly chronic kidney disease patients. SUBJECTS AND METHODS A total of 372 patients aged 65-85 years, with an estimated glomerular filtration rate of 60-15 mL/min/1.73 m2, were divided into two groups according to serum magnesium levels: hypomagnesemia, n=180; and normomagnesemia, n=192. ED was assessed through the International Index of Erectile Function-5. Hypomagnesemia is defined as serum magnesium <1.8 mg/dL. RESULTS The prevalence of ED was higher among hypomagnesemic subjects compared to that among normomagnesemics (93.3% vs 70.8%, P<0.001). Severe ED (62.8% vs 43.8%, P=0.037), mild-to-moderate ED (12.2% vs 5.2%, P=0.016), abdominal obesity (37.2% vs 22.9%, P=0.003), metabolic syndrome (38.4% vs 19.2%, P=0.026), proteinuria (0.83±0.68 vs 0.69±0.48 mg/dL, P=0.023), and C-reactive protein (6.1±4.9 vs 4.1±3.6 mg/L, P<0.001) were high; high-density lipoprotein cholesterol (48.8±14.0 vs 52.6±13.5 mg/dL, P=0.009), and albumin (4.02±0.53 vs 4.18±0.38 g/dL, P=0.001) were low in the hypomagnesemia group. Serum magnesium ≤1.85 mg/dL was the best cutoff point for prediction of ED. Hypomagnesemia (relative risk [RR] 2.27), age ≥70 (RR 1.74), proteinuria (RR 1.80), smoking (RR 21.12), C-reactive protein (RR 1.34), abdominal obesity (RR 3.92), and hypertension (RR 2.14) were predictors of ED. CONCLUSION Our data support that ED is related to hypomagnesemia in elderly patients with moderately to severely reduced kidney function.

/pdf/the-impact-of-hypomagnesemia-on-erectile-dysfunction-in-36ptbujmoi.pdf

The impact of hypomagnesemia on erectile dysfunction in elderly, non-diabetic, stage 3 and 4 chronic kidney disease patients: a prospective cross-sectional study.

Objective: Mean platelet volume (MPV) level is known to increase in diabetes mellitus (DM), and prediabetes. In this study the first aim was to compare MPV levels of individuals with normal glucose tolerance (NGT) and individuals with prediabetes or DM. The second aim was to identify whether the initial lower limit value of impaired fasting glucose (IFG) being 100 mg/dl or 110 mg/dl had any impact on MPV values.
Methods: Five hundred and six individuals included in the study were divided into 7 groups according to oral glucose tolerance test results and their MPV values were examined. Group 1 was the NGT group. The IFG group was divided into two groups with one group having fasting plasma glucose (FPG) of 100-109 mg/dl and the other a FPG of 110-125 mg/dl. Group 4 was the impaired glucose tolerance (IGT) group. The IFG and IGT combination group was divided into two with a FPG of 100-109 mg/dl and a FPG of 110-125 mg/dl. Finally, group seven was the DM group.
Results: MPV values of the NGT group were significantly lower compared to all other groups (p 0.05). In IGT group a positive correlation existed between MPV and 2 h-PG (p<0.05, r=309) and between MPV and hemoglobinA1c (p<0.05, r=463).
Conclusion: Both the DM and prediabetes group had higher MPV values compared to the NGT group. Individuals with FPG values between 100-109 mg/dl have higher MPV values than NGT. If a high MPV level is detected in individuals with a FPG of lower than 110 mg/dl, OGTT should be planned in terms of the development of DM.

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The increment of mean platelet volume in early stages of prediabetes and type 2 diabetes mellitus

Siklikla asemptomatik seyreden nefrolitiazis nadiren karin agrisi yakinmasina neden olur. Abdominal aorta anevrizma (AAA) rupturu siddetli karin agrisi yakinmasina neden olabilen olumcul bir tablodur. Her iki hastaligin tanisinda bilgisayarli tomografinin tanisal degeri yuksek olup AAA’da kontrast madde kullanilarak bilgisayarli tomografik (BT) anjiyografi uygulanilmaktadir. Bobrek fonksiyon bozuklugu olan hastalarda kontrast madde kullanimi nefropatiye neden olabileceginden tanisal amacli BT anjiyografi kullanilacaksa kontrast nefropati koruyucu onlemler alinarak islem uygulanmalidir. Bu yazimizda son donem bobrek yetmezligi tanili, karin agrisi yakinmasi ile gelen ayni anda nefrolitiazis ve 4 cm’nin altinda olan AAA rupturu tespit edilen olgunun tani ve tedavi yaklasimini sunacagiz.

/pdf/kronik-bobrek-yetmezlikli-olguda-abdominal-aorta-anevrizmasi-58812t7mn4.pdf

Yasin Sarı

Papers

Magnesium Replacement Improves the Metabolic Profile in Obese and Pre-Diabetic Patients with Mild-to-Moderate Chronic Kidney Disease: A 3-Month, Randomised, Double-Blind, Placebo-Controlled Study

The impact of hypomagnesemia on erectile dysfunction in elderly, non-diabetic, stage 3 and 4 chronic kidney disease patients: a prospective cross-sectional study.

The increment of mean platelet volume in early stages of prediabetes and type 2 diabetes mellitus

Kroni̇k böbrek yetmezli̇kli̇ olguda abdomi̇nal aorta anevri̇zmasi rüptürü ve nefroli̇ti̇azi̇s bi̇rli̇kteli̇ği̇

A case of abdominal aortic aneurysm rupture with concurrent nephrolithiasis in a patient with chronic renal failure