In the NEWS: Intravitreal Anti VEGF agents and Kidney disease

 Check out this twitter feed I had done on the topic of Intravitreal Anti VEGF agents and the Kidney. 

In the NEWS: A novel treatment for Pre eclampsia- A renal method

Soluble fms-like tyrosine kinase 1 (sFlt-1), an alternatively spliced variant of the vascular endothelial growth factor receptor 1, induces a preeclampsia-like phenotype in experimental models and circulates at elevated levels in human preeclampsia. This is the factor that leads to decreased VEGF in pre eclampsia and causes the kidney related findings. Mice studies have shown that giving VEGF can alleviate the findings; but giving VEGF might pose significant risk to the fetus. Investigators at Harvard have shown for the first time that sFLT-1 can be removed via apheresis. Dextran sulfate apheresis lowered the levels of sFlt1 and reduced proteinuria, blood pressure and allowed for fetal growth in their observational paper. This pilot study is published in the August Circulation Issue and further testing is needed in a randomized fashion with more subjects to prove this will work.  

Ref:

http://circ.ahajournals.org/content/124/8/940.abstract

http://www.thekidneydoctor.org/2011/09/preeclampsia-syndrome-affecting-5-of.html

In The News:- HIV Nephropathy and other adverse risk factors

Incidence of HIV-associated has been decreased significantly after advent of HAART. We hypothesized that patients who has sustained podocyte HIV expression before the start of HAART are vulnerable to develop HIV-associated nephropathy during the development of adverse host factors such as the activation of renin-angiotensin-sytem (because of the development of diabetes or loss of critical nephron mass as a result of nephrotoxic drugs or trauma etc) , despite having undetectable viral load. Since HIV patients are now living almost a normal life and are prone to develop diabetes and hypertension, they are likely to develop the activation of the RAS in their later life. To test our hypothesis,  HIV transgenic Vpr mice (which display doxycycline [Doxy] specific podocyte Vpr expression) with 2, 3, and 4 angiotensinogen (Agt) copies (Vpr-Agt-2, Vpr-Agt-3, and Vpr-Agt-4) were administered Doxy for 3 weeks to manifest clinically occult (in situ) HIVAN followed by Doxy-free water during the next 3 weeks. Subsequently, renal biomarkers were collected and kidneys were harvested for renal histology. Vpr mice with Agt copies did not develop proteinuria and blood pressure, and displayed minimal glomerular and tubular lesions only, without any microcyst formation. Vpr mice with 3 Agt copies showed mild glomeular and tubular lesions and microcyst formation; whereas, Vp mice 4 Agt copies exhibited moderate proteinuria, hypertension, glomerular sclerosis, tubular dilatation, microcysts and expression of epithelial mesenchymal transition markers. Moreover, Vpr mice 4 Agt copies displayed enhanced renal tissue expression of Agt, renin, and ACE and also showed higher (P<0.04) renal tissue concentration of Ang II. In addition, renal cells in Vpr mice 4 Agt copies showed enhanced expression of TGF-β, connective tissue growth factor, and vascular endothelial growth factor (VEGF). These findings indicate that adverse host factors such as the activation of the RAS, promotes the progression of clinically occult HIVAN to overt HIVAN despite the absence of active viral activity. Thus, to prevent HIVAN early detection of HIV infection (prior to renal cell infection) and treatment would be important. 

Post by Pravin Singhal, MD


Dr. Singhal is a NIH funded investigator in the Division of Kidney Diseases and Hypertension at the Hofstra NSLIJ School of Medicine, NY

Ref: http://www.ncbi.nlm.nih.gov/pubmed/21871425