Geriatric Nephrology

The Feb 2011 issue of ASN Kidney News highlights an important subset of Nephrology- Geriatric Nephrology.
A series of articles are mentioned from ESRD, Transplantation and educational opportunities in this field.
There is a society called the International Society of Geriatric Nephrology that was formed few years ago.
A Journal called Geriatric Nephrology and Urology also exists that caters to articles and studies to this important field in Nephrology.
A nephsap in Jan/Feb 2011 is going to be focused on Geriatric Nephrology as well.
Topics that are included are biology of aging and the kidney, GFR and age, glomerular diseases, geriatric hypertension, Pallative care options are a few topics.
Have a look at this months' very important issue focused on a specific theme
http://onlinedigeditions.com/publication/?m=15191&l=1

TOPIC DISCUSSION: Ageusia and ACEI/ARBS

Has anyone noted any cases of ageusia and ACEI/ARB use? Loss of taste has been reported in few case reports of these classes of agents. How does this work? Zinc depletion leads to taste disturbances. Few other drugs such as thiamazole, penicillamine cause ageusia due to zinc depletion. The active site of binding or ACEI has zinc ions. It is speculated that due to this binding, the zinc availability is decreased (perhaps more in zinc deficient patients from baseline) and leading to taste loss. Stopping the medication usually reverses it. Although when cases were looked at closely, zinc levels were normal and zinc supplementation did not return taste don't support this hypothesis.
Perhaps another mechanism might be at play

Take a look at these references:
http://www.ncbi.nlm.nih.gov/pubmed/394799
http://www.ncbi.nlm.nih.gov/pubmed/8618505
http://www.ncbi.nlm.nih.gov/pubmed/8618505
http://www.ncbi.nlm.nih.gov/pubmed/15185557

Nephrology Quiz at UKidney.com

A question set for testing your nephrology knowledge can be found on U kidney.com

http://ukidney.com/index.php?Itemid=432&option=com_joomlaquiz&view=quiz

Check it out and see if you can reach the top scorers

Disorders of Sodium & Water Balance: A mathematical approach

An interesting approach to Salt and Water Balance by Dr.Desai.

Take a look below

Disorders of Sodium & Water Balance: A mathematical approach

IN THE NEWS- Idiopathic Membranous GN and HLA-DQA1

The NEJM article just came out showing that Membranous GN has a genetic locus.

Of close to 600 Caucasian studied, two alleles were identified. Chromosome 2q24 contains the gene for the phospholipase A2 receptor, recently identified antibody against in Idiopathic membranous. Chromosome 6p21 contained the gene for HLA complex Class II HLA-DQ alpha chain 1 ( was significant in most patients identified). The PLA2R1 gene was also found to be a associated with the disease in a certain cohort. This supported a prior study that had just come out showing antibodies against phospholipase A2 in idiopathic membranous. Having two copies of the risk alleles in both genes increased the likelihood of the disease by a factor of 78. In all three cohorts studied in their paper, the researchers found a significant association with an HLA-DQA1 allele on chromosome six, while in the Dutch and British groups, they also found a significant link with the gene coding for the M-type phospholipase A₂receptor. 

Interestingly, an older study had shown some association with HLA DR3. Look below in the references. As we are learning more and more about this disease, I think that we shall soon have a better treatment option for this enigmatic disease entity.

Ref:

http://www.ncbi.nlm.nih.gov/pubmed/21323541

http://www.ncbi.nlm.nih.gov/pubmed/7314067

http://www.nature.com/ki/journal/v31/n1/abs/ki198719a.html

Skin cancer and Transplants

Talking to your patients and just educating them regarding regular skin cancer screening might be just enough to raise awareness and prevent skin cancer. Regular yearly dermatology visits for skin check ups are essential for prevention. Check out this latest healhday article.

http://consumer.healthday.com/Article.asp?AID=650075

TOPIC DISCUSSION: Is Veno-occlusive disease associated AKI different from Hepatorenal syndrome?

One of the devastating complications of bone marrow transplants is veno occlusive disease(VOD) characterized by weight gain, painful hepatomegaly, ascites, jaundice, bilirubin levels astronomically high.  This usually happens 30 days following the transplant.
VOD associated AKI is clinically not different from Hepato renal syndrome. Patients usually have a a pre renal picture with oliguria, low FENa and clinically appear volume overloaded.  Patients are either hypotensive or normotensive and hyponatremia might be present. Hence looks very similar to a cirrhotic patient with acute renal injury.  Tubular damage can be seen with granular casts in advanced disease and perhaps some component of pigment(bilirubin) nephropathy.  When kidney biopsies are done in the patients, there are no structural damages noted unless ATN has ensued.  Hence, the pathophysiology is similar to hepatorenal syndrome essentially.
Makes the injury mostly volume related or hemodynamic in nature or a "false" permanent activation of renin angiotensin system: like hepato renal syndrome

Ref:
Cancer and the Kidney, Second edition, Eric Cohen