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1
Connor, T. M. F. « A study of inherited kidney disease ». Thesis, University College London (University of London), 2013. http://discovery.ucl.ac.uk/1398923/.
Texte intégralRésumé :
Kidney disease is a common, expensive, and growing worldwide health problem. Genetic factors play an important role in the aetiology of kidney disease. Current research suggests that these genetic factors are predominantly rare variants with large phenotypic effects. In this thesis I have used a range of genetic techniques to identify rare variants in different families with kidney disease, and to study how they might cause disease. The Turkish-Cypriot population of Northern Cyprus has a high incidence of renal disease, much of which is undiagnosed and may be inherited. I collected DNA from the entire population on renal replacement therapy and identified three individuals with the G871C mutation in COL4A3. I used conflicting homozygosity analysis to demonstrate a minimal shared haplotype, thus dating this mutation to 17 generations ago. I used linkage analysis and whole genome sequencing in a large Greek-Cypriot kindred to identify 3 novel non-synonymous variants associated with kidney disease. Expression of these variants was examined in cultured primary urothelial cells from this family. I have studied another large pedigree with maternal transmission of renal disease. Sequencing of the mitochondrial genome demonstrated the presence of a novel polymorphism in the heavy strand promoter region at homoplastic levels. Mitochondrial function in primary dermal fibroblasts demonstrated a significant reduction in baseline oxidative respiration with a compensatory increase in glycolysis. Lastly, I have studied a novel compound heterozygous mutation in VHL. This variant showed abnormal degradation of HIF without activation of HIF target genes in patient-derived B-cells. It is possible that these cells are able to employ some kind of VHL-independent HIF regulatory mechanism. These studies demonstrate, in differing ways, the challenges of linking phenotype to genotype. Understanding the pathological and therapeutic importance of genetic information will become increasingly important to our management of kidney disease in this post-genomic era.
2
Manfredi, Eugene Trent. « Immunodiagnostic methods for the detection of bacterial kidney disease in salmonid fishes / ». Thesis, Connect to this title online ; UW restricted, 1986. http://hdl.handle.net/1773/5282.
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Hamel, Owen Sprague. « The dynamics and effects of bacterial kidney disease in Snake River spring Chinook salmon (Oncorhynchus tshawytscha) / ». Thesis, Connect to this title online ; UW restricted, 2001. http://hdl.handle.net/1773/6364.
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Bettge, Kathrin. « The proliferative kidney disease of salmonids : dynamics of the parasite in the fish host / ». [S.l.] : [s.n.], 2008. http://opac.nebis.ch/cgi-bin/showAbstract.pl?sys=000286556.
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Campos-Perez, Juan Jose. « The role of reactive oxygen and nitrogen species in the immune response of rainbow trout to Renibacterium salmoninarum ». Thesis, University of Aberdeen, 1998. http://digitool.abdn.ac.uk/R?func=search-advanced-go&find_code1=WSN&request1=AAIU112258.
Texte intégralRésumé :
The role of reactive oxygen and nitrogen intermediates in the immune response of rainbow trout to R.s. was investigated. The early events occurring when the pathogen interacted with trout macrophages were assessed in terms of the respiratory burst elicited. Live R.s. elicited a respiratory burst, which was enhanced by heat-killed microorganism. This phenomenon, though, was not observed using UV-killed bacteria. Both responses were enhanced when a combination of LPS and TNF was used to activate the macrophages prior to contact R.s. Further studies demonstrated that both compounds synergised to enhance superoxide (O2) production, and that this was correlated with the ability to kill the pathogen. Opsonisation of R.s. with serum factors also increased the respiratory burst, but no difference was found between normal serum and heat-inactivated serum. The role of NO in the immune response of rainbow trout is also studied. Though no evidence of NO production was found in vitro, i.p. injection of live R.s. produced higher NO levels in serum as compared to controls. Fish injected with a virulent strain showed higher levels of NO than controls and than fish injected with an avirulent strain and other strains of unknown virulence. Fish vaccinated with killed R.s. and FIA also showed a significant increase in NO levels, but only four days after vaccination, decreasing thereafter, at both doses of vaccine tested. Injected of Brivax II, an attenuated strain of Aeromonas salmonicida, did not produce a significant increase of NO. RT-PCR was used to detect the expression of the iNOS in different tissues of rainbow trout. iNOS expression was seen only in gill and kidney after i.p. injection. iNOS was detected in the gills 6 h after injecting live R.s. and the expression was still present at day 5. iNOS was detected in the kidney 24 h after injection but was switched off at day 3. After bath challenge with the bacterium, iNOS was expressed in gill, gut and kidney, but the expression varied in each fish. No iNOS expression was found in macrophages isolated from challenged fish.
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Jansson, Eva. « Bacterial kidney disease in salmonid fish : development of methods to assess immune functions in salmonid fish during infection by Renibacterium salmoninarum / ». Uppsala : Swedish Univ. of Agricultural Sciences (Sveriges lantbruksuniv.), 2002. http://epsilon.slu.se/avh/2002/91-576-6352-1.pdf.
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Mazur, Carl François. « Growth, incidence of bacterial kidney disease and immunological function of salmonids reared in captivity ». Thesis, University of British Columbia, 1991. http://hdl.handle.net/2429/30127.
Texte intégralRésumé :
Pacific salmon reared commercially off of the Coast of British Columbia suffer great mortality losses to Bacterial Kidney Disease (BKD), caused by the diplobacillus bacterium Renibacterium salmqninarum. This thesis investigates the effects of environmental conditions on the growth performance and disease susceptibility of salmonids reared in captivity. I found that growth rate of chinook salmon was significantly higher in fish fed to 100 compared to 67 % of satiation during the first 175 days of saltwater rearing but not during the first winter. Feed coversion rate was significantly higher for fish fed at 100 % of satiation compared to 67 % of satiation and higher during the winter compared to summer and fall, irrespective of feeding level. Mortality rates were significantly higher during the summer than during the fall or winter, irrespective of experimental treatment. The last BKD sampling period (day 263) revealed that infection rates were directly proportional to stocking densities of 1.5 to 4 kg.m⁻₃. Hatchery-reared chinook salmon held in freshwater aquaria had significantly lower hematocrit and plasma cortisol concentration increases in response to increased stocking density than did their wild counterparts. Crowding of hatchery-reared and wild chinook salmon resulted in equally increased mortality rates for both groups of fish. Day 33 plasma cortisol concentrations in Atlantic salmon held at three stocking densities were directly proportional to stocking densities of 8 to 64 kg.m⁻₃. The ability of anterior kidney lymphocytes from these fish to produce antibody-producing cells was inversely proportional to the density at which the fish were held.Land and Food Systems, Faculty of
Graduate
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Hill, C. « Diabetic kidney disease : a study of management and outcomes ». Thesis, Queen's University Belfast, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.676518.
Texte intégralRésumé :
Diabetes mellitus is the most common cause of end-stage renal disease requiring renal replacement therapy in the United Kingdom. However, many aspects of the prevalence, management and outcomes of diabetic patients with chronic kidney disease (CKD) remain unclear. This thesis consists of three studies using local (Northern Irish) data, national data (from the National Diabetes Audit) and international data (combined as part of a multi-centre collaborative meta-analysis). Its aims were to assess the survival of Northern Irish diabetic patients with CKD, examine the prevalence and associations of diabetes-related CKD in the UK National Diabetes Audit and to assess the association between glycosylated haemoglobin (HbA1c) and survival in diabetic haemodialysis patients.
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Gast, Christine. « A study of the genetics of chronic kidney disease ». Thesis, University of Southampton, 2015. https://eprints.soton.ac.uk/397107/.
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This study examines the prevalence and distribution of genetic kidney diseases in a cohort of chronic kidney disease (CKD) patients. The literature and national registries hold a paucity of information on genetic kidney disease prevalence in adult patients with CKD. Through a questionnaire study of all patients of the Wessex Renal and Transplant Service in CKD stages 3-5 on family history, a systematic database search and patient interviews, this study established a prevalence of genetic kidney diseases other than polycystic kidney disease(PKD) of 7.6% amongst end-stage renal disease patients and 3.8% amongst CKD patients, which is higher than previously reported. The study reveals uromodulin associated kidney disease (UAKD) to be the most prevalent genetic kidney disease after PKD, which has not been reported previously. The prevalence for UAKD in Wessex was established at 8.5 per million by UMOD gene sequencing. This is much higher than the only published prevalence of 1.7 per million in Austria. Established diagnostic biochemical tests for UAKD were evaluated and found to have relatively poor sensitivity and specificity –70 and 45% respectively in the case of the fractional excretion of urate, and 70 and 63% for urinary uromodulin, measured by enzyme linked immunosorbent assay (ELISA). On review of clinical phenotypes, hyperuricaemia and gout as the typical clinical features were not statistically associated with UAKD, highlighting the need for gene testing to establish the diagnosis. 81 patients with the clinico-pathological diagnosis focal segmental glomerulosclerosis (FSGS) were recruited to examine underlying gene mutations by a custom-designed targeted next generation sequencing (NGS) panel. Underlying gene mutations were established in 13-20% of patients, which is higher than in previous adult series. Of relevance, the most frequent mutations occurred in the collagen 4 gene, which was unexpected and changed the clinical diagnosis of these patients to Alport disease. Half of the collagen 4 mutations occurred in COL4A5, which was a previously unpublished finding. Whole exome sequencing (WES) was employed in the search for a genetic diagnosis in a previously undiagnosed family. A systematic analysis of both renal and pan-genomic variants failed to identify a disease-causing variant and illustrated the challenges of WES, leading to a discussion of future genetic investigations by NGS.
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Goldstein, D. Jordi. « Effects of selective manipulation of fatty acids in experimental chronic renal disease ». Thesis, Boston University, 1993. https://hdl.handle.net/2144/31818.
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Thesis (D.Sc.N.S.)--Boston University, Henry M. Goldman School of Graduate Dentistry, 1993 (Nutritional Sciences).Includes bibliography (leaves 176-187)
This dissertation has been presented in two related studies: A. Fish Oil Reduces Proteinuria and Interstitial Injury but not GIomerulosclerosis in the Milan Nomotensive Rat Rats of the Milan Normotensive strain (MNS) spontaneously develop severe Proteinuria and excessive glomemlar thromboxane (Tx)A2 PrOduction at a young age. These are accompanied by podocyte alterations and progressive focal glomerulosclerosis (FGS) and interstitial fibrosis. Since previous studies showed that pharmacologic... [TRUNCATED]
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Zabel, Rachel Eve. « New insights into appetite, inflammation and the use of fish oil in hemodialysis patients ». Queensland University of Technology, 2009. http://eprints.qut.edu.au/30248/.
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Protein-energy wasting (PEW) is commonly seen in patients with chronic kidney disease (CKD). The condition is characterised by chronic, systemic low-grade inflammation which affects nutritional status by a variety of mechanisms including reducing appetite and food intake and increasing muscle catabolism. PEW is linked with co-morbidities such as cardiovascular disease, and is associated with lower quality of life, increased hospitalisations and a 6-fold increase in risk of death1. Significant gender differences have been found in the severity and effects of several markers of PEW. There have been limited studies testing the ability of anti-inflammatory agents or nutritional interventions to reduce the effects of PEW in dialysis patients. This thesis makes a significant contribution to the understanding of PEW in dialysis patients. It advances understanding of measurement techniques for two of the key components, appetite and inflammation, and explores the effect of fish oil, an anti-inflammatory agent, on markers of PEW in dialysis patients. The first part of the thesis consists of two methodological studies conducted using baseline data. The first study aims to validate retrospective ratings of hunger, desire to eat and fullness on visual analog scales (VAS) (paper and pen and electronic) as a new method of measuring appetite in dialysis patients. The second methodological study aims to assess the ability of a variety of methods available in routine practice to detect the presence of inflammation. The second part of the thesis aims to explore the effect of 12 weeks supplementation with 2g per day of Eicosapentaenoic Acid (EPA), a longchain fatty acid found in fish oil, on markers of PEW. A combination of biomarkers and psychomarkers of appetite and inflammation are the main outcomes being explored, with nutritional status, dietary intake and quality of life included as secondary outcomes. A lead in phase of 3 months prior to baseline was used so that each person acts as their own historical control. The study also examines whether there are gender differences in response to the treatment. Being an exploratory study, an important part of the work is to test the feasibility of the intervention, thus the level of adherence and factors associated with adherence are also presented. The studies were conducted at the hemodialysis unit of the Wesley Hospital. Participants met the following criteria: adult, stage 5 CKD on hemodialysis for at least 3 months, not expected to receive a transplant or switch to another dialysis modality during the study, absence of intellectual impairment or mental illness impairing ability to follow instructions or complete the intervention. A range of intermediate, clinical and patient-centred outcome measures were collected at baseline and 12 weeks. Inflammation was measured using five biomarkers: c-reactive protein (CRP), interleukin-6 (IL6), intercellular adhesion molecule (sICAM-1), vascular cell adhesion molecule (sVCAM-1) and white cell count (WCC). Subjective appetite was measured using the first question from the Appetite and Dietary Assessment (ADAT) tool and VAS for measurements of hunger, desire to eat and fullness. A novel feature of the study was the assessment of the appetite peptides leptin, ghrelin and peptide YY as biomarkers of appetite. Nutritional status/inflammation was assessed using the Malnutrition-Inflammation Score (MIS) and the Patient-Generated Subjective Global Assessment (PG-SGA). Dietary intake was measured using 3-day records. Quality of life was measured using the Kidney Disease Quality of Life Short Form version 1.3 (KDQOL-SF™ v1.3 © RAND University), which combines the Short-Form 36 (SF36) with a kidney-disease specific module2. A smaller range of these variables was available for analysis during the control phase (CRP, ADAT, dietary intake and nutritional status). Statistical analysis was carried out using SPSS version 14 (SPSS Inc, Chicago IL, USA). Analysis of the first part of the thesis involved descriptive and bivariate statistics, as well as Bland-Altman plots to assess agreement between methods, and sensitivity analysis/ROC curves to test the ability of methods to predict the presence of inflammation. The unadjusted (paired ttests) and adjusted (linear mixed model) change over time is presented for the main outcome variables of inflammation and appetite. Results are shown for the whole group followed by analyses according to gender and adherence to treatment. Due to the exploratory nature of the study, trends and clinical significance were considered as important as statistical significance. Twenty-eight patients (mean age 61±17y, 50% male, dialysis vintage 19.5 (4- 101) months) underwent baseline assessment. Seven out of 28 patients (25%) reported sub-optimal appetite (self-reported as fair, poor or very poor) despite all being well nourished (100% SGA A). Using the VAS, ratings of hunger, but not desire to eat or fullness, were significantly (p<0.05) associated with a range of relevant clinical variables including age (r=-0.376), comorbidities (r=-0.380) nutritional status (PG-SGA score, r=-0.451), inflammatory markers (CRP r=-0.383; sICAM-1 r=-0.387) and seven domains of quality of life. Patients expressed a preference for the paper and pen method of administering VAS. None of the tools (appetite, MIS, PG-SGA, albumin or iron) showed an acceptable ability to detect patients who are inflamed. It is recommended that CRP should be tested more frequently as a matter of course rather than seeking alternative methods of measuring inflammation. 27 patients completed the 12 week intervention. 20 patients were considered adherent based on changes in % plasma EPA, which rose from 1.3 (0.94)% to 5.2 (1.1)%, p<0.001, in this group. The major barriers to adherence were forgetting to take the tablets as well as their size. At 12 weeks, inflammatory markers remained steady apart from the white cell count which decreased (7.6(2.5) vs 7.0(2.2) x109/L, p=0.058) and sVCAM-1 which increased (1685(654) vs 2249(925) ng/mL, p=0.001). Subjective appetite using VAS increased (51mm to 57mm, +12%) and there was a trend towards reduction in peptide YY (660(31) vs 600(30) pg/mL, p=0.078). There were some gender differences apparent, with the following adjusted change between baseline and week 12: CRP (males -3% vs females +17%, p=0.19), IL6 (males +17% vs females +48%, p=0.77), sICAM-1 (males -5% vs females +11%, p=0.07), sVCAM-1 (males +54% vs females +19%, p=0.08) and hunger ratings (males 20% vs females -5%, p=0.18). On balance, males experienced a maintainence or reduction in three inflammatory markers and an improvement in hunger ratings, and therefore appeared to have responded better to the intervention. Compared to those who didn’t adhere, adherent patients maintained weight (mean(SE) change: +0.5(1.6) vs - 0.8(1.2) kg, p=0.052) and fat-free mass (-0.1 (1.6) vs -1.8 (1.8) kg, p=0.045). There was no difference in change between the intervention and control phase for CRP, appetite, nutritional status or dietary intake. The thesis makes a significant contribution to the evidence base for understanding of PEW in dialysis patients. It has advanced knowledge of methods of assessing inflammation and appetite. Retrospective ratings of hunger on a VAS appear to be a valid method of assessing appetite although samples which include patients with very poor appetite are required to confirm this. Supplementation with fish oil appeared to improve subjective appetite and dampen the inflammatory response. The effectiveness of the intervention is influenced by gender and adherence. Males appear to be more responsive to the primary outcome variables than females, and the quality of response is improved with better adherence. These results provide evidence to support future interventions aimed at reducing the effects of PEW in dialysis patients.
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Altemtam, Nagi Abdalla Moh. « Study of the natural history of diabetic kidney disease (DKD) ». Thesis, University of Sheffield, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.574483.
Texte intégralRésumé :
Introduction: Diabetes mellitus is a global public health problem affecting an increasing number of chronic kidney disease patients. The progression of diabetic kidney disease (DKD) is variable, and the natural course of the disease may be evolving. We aimed here to revisit the natural history of DKD and to evaluate the validity of a number of urinary biomarkers in predicting the progression of DKD by determination of their independent predictive values compared to more conventional risk factors. Methods: To address this, the effects of potential risk factors on the progression of DKD was studied retrospectively in a cohort of diabetic CKD patients followed at Sheffield Kidney Institute (n = 385). Another observational prospective study was performed on 102 T2DM with DKD, 21 diabetic patients without kidney disease and 21 healthy volunteers. Each provided fresh midstream urine sample with demographic and clinical parameters collected from the unit's electronic database. Commercial ELISA kits were optimised and used to measure different urinary proteins. After cytospin, urine cells were stained using anti- fibroblast specific protein-l (FSP-l) antibody and standard cytochemistry techniques to identify potential myofibroblasts. Finally, the urine matrix metalloproteinase activity was measured by using fluoresce in conjugate substrates. Results: In the retrospective DKD cohort study, baseline proteinuria, HbA 1 c and MAP as well as the presence of vascular co-morbidities were associated with a faster rate of annual eGFR decline. Whereas, in the prospective study, albuminuria was the weakest predictor of functional outcome (ROC = 64%) and transferrinuria was the strongest (ROC = 81.2%). Furthermore, the combined score of all measured proteins did not increase the predictive value considerably (86.3%) above that of urinary transferrin. Urine cytochemistry showed that FSP-I positive cells were detected in the urine of 61 % of DKD progressors group compared to 27% of non-progressors (P = 0.004). In contrast, all slides from DM patients and healthy volunteers were negatively stained for FSP-l. The predictive value of urinary FSP I positive cells (83.6%) was superior to albuminuria as well as podocyturia (66.2%). Finally. urine MMP activity was elevated in DKD. However, there was a significantly lower MMP activity in the progressors DKD patients. Conclusions: This thesis identified a number of key observations relating to the progression of DKD. Firstly, it showed that beside conventional clinical predictors of progression, vascular comorbidities were associated with a faster rate of progression of DKD in a largely older population suffering from T2DM. Urinary biomarkers analysis showed that peptiduria and in particular transferrinuria was highly predictive of DKD progression. For the first time, we show in this thesis the potential use of urine FSP-I positive cells (presumably kidney derived myofibroblasts) to predict DKD outcomes. Also, the lower urinary MMP activity predicted a faster rate of progression. In summary, this thesis successfully identifies a number of biomarkers that may prove highly valuable to predict DKD progression in T2DM affected by diffuse vascular pathology and co-morbidities.
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Butterfield, Gareth Melgalvis. « Genetic variation for disease resistance in rainbow trout (Oncorhynchus mykiss) ». Thesis, University of Stirling, 2008. http://hdl.handle.net/1893/391.
Texte intégralRésumé :
Proliferative Kidney Disease (PKD) caused by the Malacosporean parasite Tetracapsuloides bryosalmonae, is presently the most economically damaging disease of British rainbow trout farming, costing the industry in excess of £2.5 million per annum in the UK alone. With no vaccine or prophylactic treatment available, and only management techniques currently adopted to minimise the stress and mortality associated with the disease, alternative approaches must now be considered. This document investigates if selective breeding for PKD resistance is possible by assessing the level of additive genetic variation, and calculating the subsequent estimates of heritability, for commercial strains of rainbow trout. During a PKD outbreak on a commercial farm, 1500 communally reared juvenile rainbow trout from two strains (Houghton Spring and Isle of Man) were sampled on a single day, their body weight and fork length measured, and severity of kidney swelling scored according to the scale of Clifton-Hadley et al. (1987). Fish were assigned to individual families using microsatellite parentage assignment. Significant additive genetic variation was observed in the population, and families were ranked according to estimated breeding values. A combined estimate of heritability (h2 = 0.19 ± 0.08) for kidney score suggests the population will respond well to selective breeding for kidney score, which may be deemed a measure of resistance, whilst the favourable genetic correlations between kidney score and the production traits measured suggest simultaneous selection for kidney score and growth traits should also be effective. In order to support the findings of the initial research, controlled challenge experiments were conducted. Using the family EBV information on kidney score from the IoM strain (due to its certification as a disease-free site), four females, two with high and two with low response to PKD, were each crossed with a randomly selected neomale to produce twenty two families for PKD challenge experiments. The PKD experimental challenges showed evidence of additive genetic variation to kidney score over an eleven week period, supporting initial findings. A low score was deemed as evidence of greater resistance to the parasite in this study. Although female EBV was taken into consideration in the statistical model, there was found to be no significant difference in resistance according to family. Immunohistochemistry stained kidney sections from each individual involved in the challenges proved kidney score correlated significantly to the number of parasites in the kidney, suggesting that the scale of Clifton-Hadley et al. (1987) is a sufficient and accurate basis on which to describe the severity of PKD, and infection level in rainbow trout. Having discovered evidence that furunculosis, causative agent Aeromonas salmonicida, plays a major role in the mortality of fish suffering from PKD in the field, the bacterial disease was investigated to assess the resistance of the same families used in the PKD challenges. Twenty one of the families were used to discover that additive genetic variation for resistance to furunculosis is apparent when assessed as both a binary and longitudinal trait, suggesting significant genetic improvement can be made to increase resistance to furunculosis in the IoM stock. No significant correlation was observed between kidney score, EBV, and resistance to this bacterium, but there was a positive phenotypic correlation found between furunculosis resistance and size, suggesting simultaneous selection for performance and resistance is possible within this population.
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McLoughlin, Marian Frances. « A study of pancreas disease in farmed Atlantic salmon ». Thesis, Queen's University Belfast, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.287360.
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Aasarød, Knut. « Renal involvement in inflammatory rheumatic disease : a study of renal disease in Wegener's granulomatosis and in primary Sjögren's syndrome ». Doctoral thesis, Norwegian University of Science and Technology, Faculty of Medicine, 2001. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-1471.
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Hayashi, Shirley. « Evaluation of Myocardial Function in Chronic Kidney Disease : A Colour Tissue Velocity Imaging Study ». Doctoral thesis, KTH, Medicinsk teknik, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-4729.
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In patients with chronic kidney disease (CKD), overhydration, uremic toxins and left ventricular (LV) dyssynchrony are factors that may lead to LV dysfunction and conduction abnormalities and thus contribute to the high cardiac mortality. Colour tissue velocity imaging (TVI) allows a detailed quantitative analysis of cardiac function in CKD patients, opening new possibilities to evaluate longitudinal myocardial motion, rapid isovolumetric events, LV filling pressure and LV synchronicity. Aims: Using TVI technique: 1. To evaluate myocardial function disturbances and their relations to risk factors in CKD patients. 2. To assess LV synchronicity in HD patients, both at baseline and after HD, and 3. To study acute cardiac effects of HD and i.v. furosemide in HD patients. Methods: 40 predialysis CKD (stages I, II, III, IV and V) (Study II) and 59 HD (Studies I, III, IV and V) patients were studied. In both groups of patients LV function was evaluated using TVI, and in HD patients LV synchronicity was also assessed using tissue synchronization imaging (TSI). In HD patients the evaluations were performed before and after HD (Studies III and V) and i.v. furosemide infusion (Study IV). Results: 1. TVI detected: a) LV contraction disturbances in CKD patients with LVH and normal ejection fraction. b) An increase of LV contractility after HD. c) No changes in cardiac function induced by furosemide. 2. TSI detected the presence of LV dyssynchrony and its improvement after HD. 3. In CKD, cardiac dysfunction seemed to be related to high levels of PTH, phosphate and blood pressure. Conclusions: TVI is a sensitive tool for studies on cardiac function in CKD, allowing a detailed and accurate evaluation of disturbances in LV function. TVI also provides the possibility to follow the changes in LV function and synchronicity induced by different therapeutical interventions. The obtained information may contribute to a better management of CKD patients.QC 20100809
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Hayashi, Shirley Yumi. « Evaluation of myocardial function in chronic kidney disease : a colour tissue velocity imaging study / ». Stockholm Teknik och hälsa, Technology and Health, Kungliga Tekniska högskolan, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-4729.
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Yi, Dan. « Contribution to the study of uremic toxins in the context of chronic kidney disease ». Thesis, Lyon, 2018. http://www.theses.fr/2018LYSEI054.
Texte intégralRésumé :
L'insuffisance rénale chronique (IRC) est une affection caractérisée par une perte progressive de la fonction rénale. L’IRC est associée à l'accumulation de diverses toxines urémiques. Les toxines urémiques ou solutés de rétention de l'urémie sont des composés qui s'accumulent chez les patients atteints d'IRC en raison d'un défaut de clairance rénale et qui exercent des effets biologiques délétères. Les hémodialyses éliminent mal les toxines urémiques liées aux protéines (PBUT), en raison de leur liaison aux protéines plasmatiques, en particulier la sérumalbumine humaine. En conséquence, les toxines urémiques liées aux protéines s'accumulent chez les patients atteints d'IRC et leur concentration ne peut que difficilement être diminuée chez les patients atteints d'insuffisance rénale terminale (IRT). Mes travaux sont principalement centrés sur les toxines urémiques, en particulier les toxines urémiques liées aux protéines, comme l’indoxyl-sulfate (IS), l'acide phénylacétique (PAA) et le p-crésyl-glucuronide (p-CG); et la zinc-alpha2-glycoprotéine (ZAG) qui est une « middle molécule ». Nous avons étudié le rôle de l'IS dans le développement de la résistance à l'insuline et d'autres troubles métaboliques associés à l'IRC, ainsi que ses effets sur l'inflammation et le stress oxydant. Nous avons exploré les propriétés de liaison du PAA et du p-CG à la sérumalbumine, qui est la plus abondante protéine dans le plasma humain. Enfin, nous avons essayé de développer une nouvelle stratégie d'élimination des PBUT, à l’aide de déplaceurs/compétiteurs chimiqueChronic kidney disease (CKD) is a condition characterized by progressive loss of kidney function. CKD is associated with the accumulation of various uremic toxins. Uremic toxins or uremic retention solutes are compounds that accumulate in patients with CKD due to impaired renal clearance and exert deleterious biological effects. Protein-bound uremic toxins (PBUT) is poorly removed by hemodialysis because of its binding to plasma proteins, particularly human serum albumin. As a result, protein-bound uremic toxins accumulate in patients with CKD and their concentration can hardly be reduced in patients with end-stage renal disease (ESRD). My work focuses mainly on uremic toxins, particularly protein-bound uremic toxins such as indoxyl-sulfate (IS), phenylacetic acid (PAA) and p-cresyl-glucuronide (p-CG); and zinc-alpha2-glycoprotein (ZAG) which is a "middle molecule". We investigated the role of IS in the development of insulin resistance and other metabolic disorders associated with CKD, as well as its effects on inflammation and oxidative stress. We have investigated the binding properties of PAA and p-CG to serum albumin, which is the most abundant protein in human plasma. Finally, we tried to develop a new strategy to eliminate PBUTs, using chemical displacers / competitors
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Fidler, Larry E. « A study of biophysical phenomena associated with gas bubble trauma in fish ». Thesis, University of British Columbia, 1985. http://hdl.handle.net/2429/24660.
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The condition of Gas Bubble Trauma in fish was examined in terms of specific symptoms involving bubble development in the circulatory system and buccal cavities of fish. Based on a comparison between the conditions for bubble growth in fish exposed to supersaturated water and mammals exposed to hyperbaric and hypobaric decompression a mathematical model was developed describing environmental water threshold needed to initiate bubble growth in fish. The equation development yielded expressions which related the thresholds in total dissolved gas pressure required to initiate bubble growth in the circulatory system to the partial pressure ratio of dissolved oxygen in the environmental water, oxygen uptake ratio across the gill, the size of nucleation sites in the circulatory system, the surface tension of fish blood and environmental parameters such as water temperature, depth and barometric pressure. In the case of bubble growth in the buccal cavity, environmental water thresholds were related to total gas pressure, nuclei radius, water surface tension, water temperature, depth and barometric pressure. Bubble growth thresholds were examined for a range of the above dependent parameters.Science, Faculty of
Zoology, Department of
Graduate
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Mota, Anaya Evelin, Nunes Julie Wright et Percy Mayta-Tristan. « Translation, cultural adaptation and validation of the Kidney Disease Knowledge Survey (KiKS) to Spanish ». Universidad Peruana de Ciencias Aplicadas (UPC), 2016. http://hdl.handle.net/10757/620695.
Texte intégralRésumé :
Introduction—Chronic kidney disease (CKD) affects 50 million people globally. Several studies
show the importance of implementing interventions that enhance patients' knowledge about their
disease. In 2011, the Kidney Disease Knowledge Survey (KiKS) was developed, a questionnaire
that assesses the specific knowledge about CKD in pre-dialysis patients.
Objective—To translate to Spanish, culturally adapt and validate the questionnaire KiKS in a
population of patients with pre-dialysis CKD.
Methods—The translation and cultural adaptation of KiKS was performed. Subsequently, its
validity and reliability were determined. The validity was evaluated by construct validity; and the
reliability by its internal consistency and its intra-observer reliability (test-retest).
Results—A good internal consistency was found (Kuder-Richardson = 0.85). Regarding intraobserver
reliability, the intraclass correlation coefficient with a value of 0.78 (95% CI: 0.5–1.0)
indicated a good reproducibility; the mean difference of −1.1 test-retest S.D. 6.0 (p = 0.369)
confirm this.
21
Oviasu, Osaretin. « The spatial analysis of diagnosed chronic kidney disease in Nigeria : a case study of Edo State ». Thesis, University of Sheffield, 2012. http://etheses.whiterose.ac.uk/2296/.
Texte intégralRésumé :
The thesis explores the severity of diagnosed chronic kidney disease (CKD) with particular reference to its impact in Edo state, Nigeria. There has been a scarcity of studies on the prevalence and spatial patterns of CKD in developing countries even though the costs of treatment at the late stage of the disease are extremely expensive and the inevitable outcome for the vast majority of sufferers is renal failure. CKD is a growing problem in Nigeria, presenting challenges to the nation's health and economy. This thesis presents an analysis of 442 patients with CKD referred to the renal department at the University of Benin Teaching Hospital, Nigeria, which is currently the only fully functioning CKD treatment centre in Edo state. The research study evaluates the factors that are associated with the severity of CKD in Edo State as well as the temporal and spatial trends of diagnosed CKD across the state. The results of this thesis highlights the spatial distribution of diagnosed CKD and evaluates the likely predictors for the severity of CKD at the time of diagnosis in Edo State by examining the socio-demographic and known biological risk factors such as diagnosed hypertension, and diabetes. It also highlights the areas of concern regarding the spatial distribution of diagnosed CKD within the state. Although there are attempts at raising the awareness of CKD across the study area, many patients are still being diagnosed at the last stage of the disease. This means that there is the probability that many cases are left undetected until it is too late. The findings derived from this research study would be helpful both in the policy-making decisions that pertain to the health sector and the development of a healthcare accessibility model for CKD patients that could be beneficial in the location of new healthcare centres.
22
Gorgoglione, Bartolomeo. « Heterogeneous infections in fish : transcriptomic studies on the trout immune response to single and co-infections ». Thesis, University of Aberdeen, 2014. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=210706.
Texte intégralRésumé :
Organisms are continuously exposed to heterogeneous micro- and macro-parasitic species, hence simultaneous infections often occur in wild and farm environments. This joint project aimed to develop a co-infection model between chronic and acute infections, evaluating their impact on the fish immune system. Proliferative Kidney Disease was studied on farmed rainbow and brown trout during natural seasonal outbreaks, using a parasite gene (Tetracapsuloides bryosalmonae RPL18) as a proxy for assessment of parasite burden. In hosts with elevated susceptibility PKD pathogenesis was shaped by an anti-inflammatory phenotype, a profound B cell/antibody response and dysregulated TH cell-like activity. Pathogen-free brown trout were exposed to Viral Haemorrhagic Septicaemia Virus (comparatively using European VHSV-Ia and North American VHSV-IVb strains) or to the bacterium Yersinia ruckeri. This European native species was highly resistant to the VHSV-IVb strain, which was undetectable in internal organs despite raising a strong antiviral and mucosal immune response. Following VHS and Yersiniosis infection, haemo-lymphopoietic organs were screened by RT-qPCR to assess the specific pathogen burdens and characterise the immune responses elicited. Transcription patterns were analysed for Interferons, CXC chemokines, SOCS (potential disease resistance biomarkers) and genes of the PACAP system. Lastly, PKD-infected brown trout were co-infected with VHSV-Ia, resulting in typical lesions while showing reduced and delayed mortality. PKD+/VHS+ fish were identified by RT-qPCR and histopathology screening. Pro-inflammatory and antimicrobial peptide genes were modulated following virus co-infection when compared to fish with single infection, with an earlier activation of cellular and humoral responses, and a stronger up-regulation of TH1 and antiviral genes. Oligonucleotide microarrays were used to assess the broader immune gene transcription modulation between single- and co-infected fish. Overall, the results suggest that the immune response of brown trout might be enhanced during the PKD/VHS co-infection.
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Mota, Anaya Evelin, Cárdenas Daniel Yumpo, Bravo Edmundo Alva, Nunes Julie Wright et Percy Mayta-Tristan. « Spanish version of the Kidney Disease Knowledge Survey (KiKS) in Peru : cross-cultural adaptation and validation ». The National Center for Biotechnology Information, 2016. http://hdl.handle.net/10757/620670.
Texte intégralRésumé :
INTRODUCTION
Chronic kidney disease (CKD) affects 50 million people globally. Several studies show the importance of
implementing interventions that enhance patients’ knowledge about their disease. In 2011 the Kidney
Disease Knowledge Survey (KiKS) was developed: a questionnaire that assesses the specific knowledge
about chronic kidney disease in pre-dialysis patients.
OBJECTIVE
To translate to Spanish, culturally adapt and validate the Kidney Disease Knowledge Survey
questionnaire in a population of patients with pre-dialysis chronic kidney disease.
METHODS
We carried out a Spanish translation and cross-cultural adaptation of the Kidney Disease Knowledge
Survey questionnaire. Subsequently, we determined its validity and reliability. We determined the
validity through construct validity; and reliability by evaluating its internal consistency and its intra-
observer reliability (test-retest).
RESULTS
We found a good internal consistency (Kuder-Richardson = 0.85). The intra-observer reliability was
measured by the intra-class correlation coefficient that yielded a value of 0.78 (95% CI: 0.5-1.0). This
value indicated a good reproducibility; also, the mean difference of -1.1 test-retest SD 6.0 (p = 0.369)
confirms this finding.
CONCLUSION
The translated Spanish version of the Kidney Disease Knowledge Survey is acceptable and equivalent
to the original version; it also has a good reliability, validity and reproducibility. Therefore, it can be
used in a population of patients with pre-dialysis chronic kidney disease.
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Olsen, Lisa. « Reliabe volume measurements in ADPKD patients : a study of MRI sequences ». Thesis, Boston University, 2013. https://hdl.handle.net/2144/21227.
Texte intégralRésumé :
Thesis (M.A.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is characterized by gradual kidney enlargement and cyst growth prior to loss of kidney function. The Consortium for Radiologic Imaging Studies in Polycystic Kidney Disease (CRISP) created a standard magnetic resonance imaging (MRI) protocol to be used for ADPKD patients to determine if changes in total kidney volumes can be detected over a short period of time, and if they correlate with decline in renal function early in the disease course. CRISP guided researchers and physicians to use a T1-weighted sequence with gadolinium contrast to measure kidney volumes. After the Food and Drug Administration discouraged the use of gadolinium contrast in individuals with kidney diseases, total kidney volume measured by MRI for ADPKD patients was done using the T1-weighted pulse sequence without contrast enhancement. STUDY OBJECTIVE: The retrospective cohort study will aim to assess reliability of the T2 sequence and total kidney volume measurements compared to total kidney volume measurements performed on a T1 sequence. METHODS: The study collected intra-reader and inter-reader cases from four imaging studies, each with an abdominal MRI performed. Repeated volume measurements were performed within an individual reader (intra-reader) and between different readers (inter-readers). The stereology method was used to quantify kidney volume from T1 images for three studies and T2 images for one study. Mean and standard deviation were used to analyze volume differences between repeated measurements for intra-reader and inter-reader data for each MRI sequence. The intra-class correlation coefficient and Bland-Altman plot were used to describe correlation between kidney volumes, for intra-reader and inter-reader data respectively. RESULTS: Analyses show a significant difference in the repeated volume measurements from the T1 sequence in inter-reader data. Reliability for the T2 and T1 sequence was represented by high correlations in both the intra-reader and inter-reader total kidney volumes. CONCLUSION: MR measures of total kidney volume are reliable in patients when measured on both the T1 sequence and the T2 sequence. ADPKD kidney volumes for future clinical trials can be reliably measured on either sequence.
2031-01-01
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Marks, Angharad. « Outcomes and epidemiology of chronic kidney disease : the first Grampian laboratory outcomes morbidity and mortality study (GLOMMS-I) ». Thesis, University of Aberdeen, 2013. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=202777.
Texte intégralRésumé :
To identify those with kidney disease early and thus facilitate earlier instigation of disease-progression slowing treatments, new definitions of chronic kidney disease (CKD) were introduced in 2002 (KDOQI). After this, the worldwide introduction of estimated glomerular filtration rate (eGFR) reporting (2006 onwards), also facilitated more widespread identification of those with CKD. Prognosis in those with CKD identified in this way was not known and the numbers with CKD appeared higher than originally expected. This thesis aimed to improve understanding of outcomes in those who met the definition of chronic kidney disease and facilitate better directed care. Data-linkage of several healthcare datasets including to laboratory, morbidity and mortality healthcare data for individuals in the Grampian region with measures of renal function in 2003 allowed those aims to be addressed. Patterns in the testing of kidney function over time were also described. Mortality and RRT initiation during the GLOMMS-I cohort's 6.5 years of follow-up were described, as were variables that were associated with these outcomes. Other measures of decline of kidney function over time (progression), were explored and compared to the ultimate measure of progression - the initiation of RRT. Various models to predict outcomes (RRT initiation, mortality and survival) were explored. Measures of model performance including discrimination, calibration, goodness of model fit and predictive performance were described. Overall the aim of this thesis was met - to improve the understanding of the prognosis of those currently labelled with chronic kidney disease. The work in this thesis has also provided the necessary information to plan and start a much wider population based study of outcome in those both with and without CKD (GLOMMS-II).
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Basnayake, Kolitha Indika. « The biology of immunoglobulin free light chains in kidney disease : a study of Monoclonal and Polyclonal light chains ». Thesis, University of Birmingham, 2012. http://etheses.bham.ac.uk//id/eprint/2862/.
Texte intégralRésumé :
Monoclonal immunoglobulin free light chains (FLCs) cause a range of disorders in the kidney. In multiple myeloma, FLCs can activate the proximal tubule to release MCP-1, an important cytokine in renal fibrosis. Distal tubular cast formation can also occur when FLCs co-precipitate with uromodulin. However a pathogenic role for the elevated polyclonal FLC concentrations seen in chronic kidney disease has not been assessed to date. This thesis explores the biology of monoclonal FLCs as well as polyclonal FLCs. Detailed histological analyses demonstrated that in multiple myeloma, interstitial fibrosis can progress rapidly in situ and indicated that intratubular cast numbers might be linked to potential for renal recovery. The functional basis of this fibrosis was explored by in vitro studies, which showed that upon endocytosis of FLCs, oxidative stress activated redox signalling, resulting in MCP-1 production. Further in situ analyses showed that in chronic kidney disease, polyclonal FLCs co-localised with uromodulin in distal tubular casts. Relationships between these casts and markers of progression of chronic kidney disease were demonstrated. In vitro analyses then showed that polyclonal FLCs bind to uromodulin and promote aggregation. These findings: (i) further delineate the pathways for proximal tubular injury in myeloma and (ii) indicate a potential pathogenic role for polyclonal FLCs in the distal nephron.
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He, Jiang, Michael Shlipak, Amanda Anderson, Jason A. Roy, Harold I. Feldman, Radhakrishna Reddy Kallem, Radhika Kanthety et al. « Risk Factors for Heart Failure in Patients With Chronic Kidney Disease : The CRIC (Chronic Renal Insufficiency Cohort) Study ». WILEY, 2017. http://hdl.handle.net/10150/625054.
Texte intégralRésumé :
Background-Heart failure is common in patients with chronic kidney disease. We studied risk factors for incident heart failure among 3557 participants in the CRIC (Chronic Renal Insufficiency Cohort) Study. Methods and Results-Kidney function was assessed by estimated glomerular filtration rate (eGFR) using serum creatinine, cystatin C, or both, and 24-hour urine albumin excretion. During an average of 6.3 years of follow-up, 452 participants developed incident heart failure. After adjustment for age, sex, race, and clinical site, hazard ratio (95% CI) for heart failure associated with 1 SD lower creatinine-based eGFR was 1.67 (1.49, 1.89), 1 SD lower cystatin C-based-eGFR was 2.43 (2.10, 2.80), and 1 SD higher log-albuminuria was 1.65 (1.53, 1.78), all P< 0.001. When all 3 kidney function measures were simultaneously included in the model, lower cystatin C-based eGFR and higher log-albuminuria remained significantly and directly associated with incidence of heart failure. After adjusting for eGFR, albuminuria, and other traditional cardiovascular risk factors, anemia (1.37, 95% CI 1.09, 1.72, P= 0.006), insulin resistance (1.16, 95% CI 1.04, 1.28, P= 0.006), hemoglobin A1c (1.27, 95% CI 1.14, 1.41, P< 0.001), interleukin-6 (1.15, 95% CI 1.05, 1.25, P= 0.002), and tumor necrosis factor-a (1.10, 95% CI 1.00, 1.21, P= 0.05) were all significantly and directly associated with incidence of heart failure. Conclusions-Our study indicates that cystatin C-based eGFR and albuminuria are better predictors for risk of heart failure compared to creatinine-based eGFR. Furthermore, anemia, insulin resistance, inflammation, and poor glycemic control are independent risk factors for the development of heart failure among patients with chronic kidney disease.
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Fish, R. S. « A study of the P2X7 purinoceptor and vascular ATP metabolic pathways in chronic kidney disease-associated arterial calcification ». Thesis, University College London (University of London), 2014. http://discovery.ucl.ac.uk/1456574/.
Texte intégralRésumé :
The risk of cardiovascular-related death is several-fold higher in patients with chronic kidney disease (CKD) compared with the general population. Arterial calcification (AC) is extremely common in patients with CKD and strongly associates with cardiovascular-related mortality, however, there are currently no specific treatments to prevent its development and/or progression. Abundant evidence now suggests that AC is cell-mediated and actively-regulated, involving mechanisms linked to bone homeostasis, production of calcification inhibitors and vascular smooth muscle cell (VSMC) function. The P2X7 receptor (P2X7R) is an ATP-sensitive cation channel which has been implicated in several biological processes, in non-vascular contexts, thought to be important in the aetiology of AC. In addition, disruption to the normal function of some enzymes involved in ATP metabolism has been shown to contribute to AC, although little is known about their role in CKD-related arterial calcium deposition. The work in this thesis tested the primary hypothesis that P2X7R contributes to the pathogenesis of CKD-associated AC. Preliminary work was also conducted to examine the expression of components of the ATP-metabolising system in this clinical setting. P2X7R expression was confirmed in human and rodent vascular smooth muscle but was un-affected by calcification. In vitro, the P2X7R-specific antagonist, A438079, did not influence calcium deposition occurring in the presence of human VSMCs or segments of rat aorta exposed to ‘calcification-promoting’ medium. Calcification of cultured rat aorta was also not influenced by a second P2X7R-specific antagonist, A839977, or by BzATP (a receptor agonist). Aortic rings from mice deficient in P2X7R calcified to a similar extent to wild-type controls in vitro. A novel, adenine-based mouse model was developed to evaluate the effect of P2X7R gene deficiency on CKD-associated AC in vivo. However, the number of mice exhibiting AC in the final experiment was too low to draw any firm conclusion. Therefore, rats were fed an adenine-containing, high phosphate diet for 4 weeks (to induce CKD and AC) and administered a selective P2X7R antagonist, twice daily, throughout this period. Pharmacological blockade of P2X7R did not influence the magnitude of aortic calcification in this model. Quantification of mRNA performed on tissue obtained from the in vivo rat experiment suggested that VSMC-specific markers are down-regulated in calcified arteries, although VSMC osteogenic transformation, which is widely reported in the literature to occur in the context of AC, was not detected. Expression of the apoptosis marker, caspase-3, was increased in calcified arteries in vivo. P2X7R blockade did not influence any of these changes in mRNA expression. Expression of mRNA for ENPP-1, an ATP-metabolising enzyme responsible for the generation of the calcification inhibitor, pyrophosphate (PPi), was significantly increased in calcified arteries from CKD rats. Functional activity of ENPP-1 was also increased in these vessels. The expression of mRNA for other components of the ATP-metabolising system was also in keeping with an attempt by VSMCs to generate more PPi, possibly as an adaptive, defensive response to uraemic, calcification-promoting factors. Furthermore, an increase in ENPP-1 mRNA expression was detected in calcified inferior epigastric arteries from patients with end-stage renal disease (extracted at the time of kidney transplantation). In summary, P2X7R does not appear to contribute to the pathogenesis of CKD-associated AC, although this should be confirmed in experimental models which more closely simulate human disease. Arterial expression of enzymes involved in the metabolism of ATP does seem to change in AC. Future work should therefore focus on gauging the clinical relevance of this in order to better understand the mechanisms underlying the disease and potentially develop new therapeutic interventions.
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Oswald, Lara Andreia Silva. « Feline hyperthyroidism : a longitudinal comparative study of patients in the presence or absence of concurrent chronic kidney disease ». Master's thesis, Universidade de Lisboa. Faculdade de Medicina Veterinária, 2015. http://hdl.handle.net/10400.5/10247.
Texte intégralRésumé :
Dissertação de Mestrado Integrado em Medicina VeterináriaABSTRACT - Feline Hyperthyroidism: a longitudinal comparative study of patients in the presence or absence of concurrent chronic kidney disease - Feline hyperthyroidism is the most common endocrinopathy of the domestic cat and is caused by the multi-systemic effects of increased circulating concentrations of thyroid hormones T3 and T4. Geriatric feline patients also frequently suffer from concurrent chronic kidney disease, often only noticeable when thyrotoxicosis is addressed and the glomerular filtration rate diminishes, allowing the diagnosis of this underlying disease. The prediction or detection of underlying renal disease is vital for the establishment of appropriate treatment and avoiding further renal damage. Laboratorial screenings are seldom valuable in its diagnosis, as hyperthyroidism “masks” many of the alterations associated with the renal disorder. This study shows that serum concentrations of urea may be used as a diagnostic indicator of chronic kidney disease, with a 70% sensitivity. Determination of a cut-off value of 11.6 mmol/L and 135.5 μmol/L for reference levels of serum concentrations of urea and creatinine, respectively, proved to significantly beneficial as diagnostic indicators of underlying chronic kidney disease, with a sensitivity and specificity of 80% and 92%, correspondingly, for the cut-off value of serum urea and 30% and 100%, correspondingly, for the cut-off value of serum creatinine. These findings may represent the solution for the diagnostic challenge that these patients represent.
RESUMO - Hipertiroidismo felino: um estudo longitudinal comparativo de pacientes na presença ou ausência de doença renal crónica concomitante - O hipertiroidismo felino é a endocrinopatia mais comum do gato doméstico e é causada pelos efeitos multisistémicos de concentrações séricas aumentadas das hormonas tiroideias T3 e T4. O gato geriátrico sofre também frequentemente de doença renal crónica concomitante, apenas detectável aquando do tratamento da tirotoxicose e diminuição da taxa de filtração glomerular, permitindo o seu diagnóstico. Prever ou detectar esta doença concomitante é vital para o estabelecimento do tratamento apropriado e prevenção de maior lesão renal. As análises laboratoriais raramente são úteis no seu diagnóstico, uma vez que o hipertiroidismo “mascara” muitas das alterações associadas com patologia renal. Este estudo mostra que concentrações séricas de ureia podem ser usadas como indicador de diagnóstico de doença renal crónica, com uma sensibilidade de 70%. A determinação de valores limiares de 11.6 mmol/L e 135.5 μmol/L para as concentrações séricas de ureia e creatinina, respectivamente, provaram ser adequadas como indicadores de diagnóstico de doença renal crónica subjacente, com uma sensibilidade e especificidade associadas de 80% e 92%, respectivamente, para o valor limiar de ureia sérica; e 30% e 100%, respectivamente, para o valor limiar de creatinina sérica. Estes achados poderão representar a solução para o desafio clínico que estes pacientes representam.
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Romick-Rosendale, Lindsey Elizabeth. « USE OF NMR-BASED METABONOMICS TO STUDY ANIMAL MODELS AND HUMAN DISEASE ». Miami University / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=miami1321891202.
Texte intégral
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AlGhadban, Samy Taha Abdo. « The production and use of transgenic mouse models to study the role of complement pathway activation in progressive kidney disease ». Thesis, University of Leicester, 2017. http://hdl.handle.net/2381/40035.
Texte intégralRésumé :
The complement system mediates inflammatory diseases, including kidney disease, through one or more of three pathways named the classical, the alternative and the lectin pathway. The existing experimental data do not allow comprehensive understanding of the individual complement pathway or pathways that mediate the renal injury. This study therefore aimed to determine the complement pathway(s) that are involved in mediating the injury in three models of kidney disease: protein overload proteinuria, unilateral ureteric obstruction nephropathy and adriamycin nephropathy. In protein overload proteinuria, a highly significant increase in the expression levels of TGF-β, TNF-α and IL-6 was observed in WT mice compared to the lectin pathway deficient mice. Macrophage infiltration, apoptosis and the expression of the gene for Col4α1 were also significantly increased. These data suggested a significant role for the lectin pathway in mediating the injury. Most interestingly, the results indicated that antibody mediated inhibition of the lectin pathway led to less injury in some of the examined parameters. These data might suggest a novel therapeutic approach to relief the renal injury in proteinuric nephropathies by targeting the activation of the lectin pathway. In unilateral ureteric obstruction nephropathy, results indicated that deficiency in either the lectin or the classical pathways led to reduced macrophage infiltration and renal fibrosis. The expression levels of Il6, Ifn-γ, TGFβ-1 and Col4α1were reduced in the lectin pathway deficient mice but not in C1qKO mice when compared to WT. However, lower expression levels of these genes were not up to statistical significance. These data suggested that both the lectin and the classical pathways mediate the injury. Similarly, adriamycin nephropathy mice deficient in the lectin pathway showed significant reduction in renal inflammation and fibrosis when compared to WT mice. Additionally, two gene targeting approaches were utilized in order to establish a novel mouse line with specific deficiencies of both the lectin and the classical pathways of the complement. This mouse model should provide a powerful tool to investigate the possible synergetic cooperation between these two pathways in mediating inflammatory renal pathology.
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Kok, Elandré. « Erythropoietin treatment in anaemic patients at the Nephrology Unit of the Steve Biko Academic Hospital - a retrospective, cross-sectional study ». Diss., University of Pretoria, 2020. http://hdl.handle.net/2263/76007.
Texte intégralRésumé :
Anaemia in chronic kidney disease (CKD) mostly results from a decrease in the production of erythropoietin (EPO) by the failing kidney. CKD progression requires treatment with erythropoiesis-stimulating agents and iron supplementation to ensure sufficient erythrocyte production. Best clinical practice guidelines should be adhered to in managing CKD to reduce morbidity and mortality related to anaemia associated cardiovascular disease. Likewise, guideline deviations create an increased strain on the resources of the treatment facility. It is uncertain to which extent these guidelines are followed by Nephrology Units in the public healthcare sector, or whether the documented international trends are prevalent locally due to the paucity of local data, and therefore further investigation is warranted. This study aimed to assess treatment trends in managing anaemia in CKD patients at the Steve Biko Academic Hospital (SBAH).
Files of patients receiving treatment at the SBAH Nephrology Unit between 2 January 2018 - 31 August 2018 were reviewed. Only individuals with stage 5 CKD receiving either haemodialysis, or peritoneal dialysis were included, while those with less than three months’ treatment were excluded. Measured variables included demographical information, current EPO treatment and/or iron supplementation regimens versus serum haemoglobin/iron levels and quantity of administered blood products.
Ninety-seven patients met the inclusion criteria. Haemodialysis accounted for 43% (n = 42), and peritoneal dialysis 57% (n = 55). Intergroup comparison between the number of results where both haemoglobin and iron were within the target range versus the number of results where both parameters fell outside the target range yielded a significant difference (p = 0.0031). Patients receiving peritoneal dialysis reached serum haemoglobin and iron levels closer to normal target values compared to those receiving haemodialysis.
Managing anaemia in CKD is a complex process. More stringent iron control, especially for patients receiving haemodialysis, including the administration of long-acting EPO preparations once a month, is proposed. The latter will contribute to the improvement of clinical outcomes of patients with CKD.
Keywords: Chronic kidney disease, anaemia, erythropoiesis stimulating agent, haemoglobin, ironDissertation (MSc (Pharmacology))--University of Pretoria, 2020.
Pharmacology
MSc (Pharmacology)
Unrestricted
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Yarkiner, Zalihe. « Developing longitudinal models for monitoring chronic diseases in computerised general practice (GP) records : a case study in chronic kidney disease (CKD) ». Thesis, Kingston University, 2015. http://eprints.kingston.ac.uk/34536/.
Texte intégralRésumé :
Analysis of longitudinal data is a rapidly growing field of statistical analysis, in response to the increasing availability of longitudinal datasets in many disciplines. Longitudinal studies are becoming more popular as they allow investigation of the same individuals over time, and where both within-individual and between-individual differences can be examined. Since the study of change over time is necessary in many areas, longitudinal studies and meaningful analysis of longitudinal data is essential. The health sector is one such area where longitudinal research is playing an increasingly important role. The aim of this research is to examine statistical methodologies for the analysis of longitudinal medical data, specifically General Practice (GP) records. All General Practices (GPs) in England and Wales are now computerized and routinely record detailed patient information, hence providing a rich longitudinal dataset. This research investigates new techniques and adaptations of existing methodologies to understand and explain patterns of change and the natural development and treatment of chronic diseases within routinely collected GP data. The data used here, although taken from a raw sample of 129 General Practice records, have been subjected to some cleaning and recoding in places, hence it should be considered as a secondary data source. Through out the data driven applications presented, different sub¬samples of the original dataset have been used. For the main part the full cleaned sample of 876951 patients is used where possible. Smaller samples ranging between 472 and 58675 patients are used depending on the outcome of interest and the availability of valid observations for the various applications employed. Mainly regression-based techniques, in two broad categories, were used to analyse the repeated measurements from each patient in our dataset. Firstly, linear and generalized mixed modelling approaches were used, whereas in the second phase of the project, the applications of semi-parametric and non-parametric approaches were investigated. The case study of particular interest in this research project is the incidence and progression of chronic kidney disease (CKD). There is a lack of knowledge and understanding of the natural history ofCKD and its progression over time. This project aims to address these issues. The advanced statistical models used in this research quantify how kidney function, assessed using estimated Glomerular Filtration Rate (eGFR), changes with respect to time and how other factors, including other related medical conditions (known as co-morbidities of CKD), affect kidney function and its change over time. The techniques and approaches used in this study are motivated by mixed model designs. The decline of kidney function as time progresses for typical CKD patients is observed to be non-linear. The type of nonlinear mixed models developed in this project do not assume that the decline of eGFR over time is linear, and hence are better able to model the progression of CKD than more traditional linear models. As a consequence, the proportion of the total variation in the outcome that can be explained by considering the patient level factors is tripled through the use of these non-linear models, showing they have much greater explanatory power than previous, simpler statistical models. The disease under study is Chronic Kidney Disease (CKD) but the methodologies should also be applicable other chronic, progressive diseases.
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Joshi, Avani. « Utilization patterns and economic impact of IV iron and Erythropoiesis Stimulating Agents in Chronic Kidney Disease patients : A multi-hospital study ». VCU Scholars Compass, 2010. http://scholarscompass.vcu.edu/etd/2278.
Texte intégralRésumé :
Background: Chronic kidney disease (CKD) affects approximately 20 million Americans and is the cause of significant morbidity and mortality. Anemia, common in CKD, develops early in the disease process. It contributes to increased risk of cardiovascular disease, hospitalization, mortality, and diminishes health-related quality of life. Intravenous iron and Erythropoiesis Stimulating Agents (ESAs) are recommended for anemia management in CKD. The utilization patterns of IV iron and ESA, and their impact on hospital costs and length of stay merits investigation. Objectives: There were five general objectives of this investigation. The rate and extent of utilization of IV iron in anemic CKD patients was quantified across teaching hospitals in the US. Patient characteristics of those receiving IV iron and ESA and ESA alone were evaluated in detail. Predictors of IV iron and ESA use were determined. The impact of IV iron and ESA use was examined separately for total hospital costs and length of stay (LOS) while adjusting for confounding. Methods: This is a retrospective cohort analysis within the University Health System Consortium data warehouse. Eligible patients are those who were admitted to a hospital and received either IV iron and ESA or both at least once during the period of January 1, 2006, and December 31, 2008. Inclusion criteria include age > 18 years old with a primary or secondary diagnosis of CKD. The exposure of interest was IV iron and ESA therapy, and the outcome was the difference in total hospital costs and length of stay between patients only on ESA, and those on ESA and IV iron. A clustered binomial logistic regression using the GEE methodology was used to identify predictors of IV iron utilization. Propensity scores were used to control for confounding. A generalized estimating equations (GEE) model using a gamma distribution and log link was used to determine the adjusted hospital cost and length of stay for the IV iron and ESA and ESA alone therapy groups. Results: During the study period, 82,947 patients met all the inclusion and exclusion criteria. Of the 82,947 CKD patients on ESA therapy, only 8% (n = 6678) patients were on IV iron supplementation. Age, race, primary payer, admission status, severity of illness, dialysis status and physician specialty were identified as strong predictors of IV iron use in CKD patients. According to the multivariate model, the overall mean hospital cost for all 82,947 patients was $31,674. For patients using both IV iron and ESA (n=6678), mean costs were $34,756 compared to $31,404 for ESA users alone (n=76,269) – a difference of $3,352. The overall mean LOS for all patients was 9.75 days. For those using IV iron, the LOS was 10.71 days, and for those only using ESA, the LOS was 9.66 days– a difference of approximately 1 day. Conclusions: This inquiry is the first large multi-center investigation to quantify the impact of IV iron and ESA use on total hospital costs and LOS. Our investigation showed significant reduction in ESA doses with the use of IV iron supplementation, however, the overall prevalence of IV iron usage was low. Intravenous iron users were associated with a higher total hospital cost and longer length of stay than ESA users.
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Blackwell, Kara. « The impermanence of reality : a grounded theory study of the experience of transition to palliative care for people with end-stage kidney disease (ESKD) ». Thesis, University of Surrey, 2017. http://epubs.surrey.ac.uk/813806/.
Texte intégralRésumé :
There has been an increasing recognition over the last ten years of the importance of integrating palliative care alongside other aspects of care for people with life-limiting illness including kidney disease. Over the same time period, policy initiatives have aimed to address and improve the end of life care for all adults with kidney disease. However, little is known about the transitions experienced by people with end-stage kidney disease (ESKD) as they approach the end of life. This qualitative study explored the transitions experienced by people with ESKD as they approached the end of their lives. A constructivist grounded theory methodology was used, and unstructured interviews were conducted with twelve people living with ESKD who were deemed to be approaching the end of their lives. The interview data were analysed and interpreted using the constant comparative method. The core category of ‘restructuring reality’ emerged from the data analysis alongside three dynamic, interrelated conceptual categories and the subcategories within these. These conceptual categories were: ‘striving to maintain autonomy and control in decision making’, ‘managing uncertainty: knowing without clarity or confirmation’, and ‘the importance of personal virtues in transitioning through the illness’. The substantive theory which emerged from the data analysis and which conceptualised the process and experience of transition for people with ESKD in this study was defined as 'the restructuring of reality during transition for people with ESKD approaching the end of life’. The study findings provided valuable insight into the experience of people with ESKD as they approach the end of their lives. The tentative theory presented in this study added to the knowledge of the transitions experienced by people with ESKD as they approached the end of their life. The theory captured how participants made sense of and adjusted to the changes they experienced as their health deteriorated; it emphasised that being able to continue to contribute and be involved in decision-making about care was an important aspect of the transition process as people approached the end of their lives. The study findings also highlighted the importance of healthcare professionals undertaking end of life discussions with patients throughout their illness trajectory to ensure people with ESKD are afforded the opportunity to be involved in timely decision making and provided with good quality end of life care.
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Sedgewick, John M. « Older peoples' views of choice and decision-making in chronic kidney disease : a grounded theory study of access to the social world of renal care ». Thesis, University of Sheffield, 2017. http://etheses.whiterose.ac.uk/20297/.
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Simba, Kudakwashe. « The impact of vascular calcification among dialysis dependent South African CKD patients. A five year follow up study. Cardiovascular mortality and morbidity, ethnic variation and hemodynamic correlates ». Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31257.
Texte intégralRésumé :
BACKGROUND
Vascular calcification is a major risk factor for cardiovascular morbidity and mortality in patients with end stage renal disease (ESRD). In Western countries, Blacks with ESRD appear to have lesser degrees of vascular calcification compared to non-Blacks. However, there is no published data on the association of ethnic differences in vascular calcification and survival in ESRD from Sub-Saharan Africa.
METHODS
This study assessed the 5-year change in vascular calcification and mortality in a previously published cohort of patients with ESRD. Vascular calcification was assessed by abdominal aortic calcification score (lateral abdominal radiograph) and vascular stiffness by pulse wave velocity.
RESULTS
Sixty-six of the original 74 participants, studied a baseline, were identified. The median age was 46.6 years (37.6-59.2) and 57.6% were women. Abdominal aortic calcification showed no progression among Blacks [baseline range 0-5, follow up range 0-8 (p=1.00)], but a nonsignificant trend to progression among non-Blacks [baseline range 0-19, follow up range 0-22 (p=0.066)]. Black participants did not display a survival advantage (p=0.870). Overall, sepsis was the most common cause of mortality (64% of those with an identifiable cause of death). Non-Blacks had higher parathyroidectomy rates than Blacks with 9/30 cases compared to 2/36 (p=0.036). After adjustment for parathyroidectomy at follow up, the odds ratio of having abdominal vascular calcification score of ≥1 amongst non-Blacks was 8.6-fold greater compared to Blacks (p= 0.03). Central aortic systolic pressures (CASP) and pulse wave velocities (PWV) were higher in the study population than age matched normative values. At follow up, a positive correlation (r=0.3) was observed between PWV and abdominal aortic calcification (p=0.04). Elevated baseline coronary artery calcification score and FGF-23 level at baseline were not associated with a difference in mortality.
CONCLUSION
There was no significant progression in vascular calcification among Blacks. After adjusting for increased parathyroidectomy rates, there was a greater progression of vascular calcification amongst non-Blacks compared to Blacks highlighting possible ethnic differences in calcium phosphate metabolism in patients with ESRD. The lack of vascular calcification progression in Blacks was not however associated with improved survival, but the sample size was small.
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Månsson, Lisa. « Visualizing the dynamic interplay between the host and bacterial pathogen : a real-time study of renal infection / ». Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-218-7/.
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Herrington, William Guy. « What are the effects of lowering LDL-cholesterol on risk of stroke in chronic kidney disease ? : evidence from the Study of Heart and Renal Protection (SHARP) ». Thesis, University of Cambridge, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.607722.
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40
Kerkar, Nanda. « Study of cytochrome P4502D6, target of Liver Kidney Microsomal antibody type 1 in autoimmune hepatitis type 2 and chronic liver disease due to hepatitis C virus infection ». Thesis, University College London (University of London), 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.395159.
Texte intégral
41
Bergander, Liza, et Charlotta Bäckman. « Erfarenheter av egenvård för individer med kronisk njursjukdom : En litteraturstudie ». Thesis, Umeå universitet, Institutionen för omvårdnad, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-178708.
Texte intégralRésumé :
Bakgrund: Kronisk njursjukdom drabbar mer än var 10:e människa världen över. Sjukdomen är komplex och kan ses i samband med andra sjukdomar. Individer behöver utföra en livslång och krävande egenvård av denna progressiva sjukdom. I dagens hälso- och sjukvård vårdas vanligtvis en sjukdom i taget vilket kan få vården att brista i individanpassat egenvårdsstöd. Syfte: Syftet med litteraturstudien är att beskriva erfarenheter av egenvård för individer med kronisk njursjukdom. Metod: En kvalitativ litteraturstudie baserad på åtta empiriska studier. Artiklarna hämtades från databaserna PubMed och Cinahl. Innehållsanalysen gjordes utifrån Fribergs femstegsmodell. Resultat: Två kategorier och sju underkategorier skapades utifrån resultatet. Kategorierna; 1) Hälsorelaterade värderingar och upplevelser påverkar egenvården 2) Behov av stöd för att utföra egenvård. Konklusion: Litteraturstudien visar att individer kan uppleva ångest och oro över sitt hälsotillstånd vilket försvårar utförandet av egenvård. Hälso- och sjukvården behöver ha ett personcentrerat bemötande och beakta individens beteenden och värderingar för att kunna ge en individanpassad information och ett kontinuerligt egenvårdsstöd. Därefter kan individen få en god förutsättning att ta till sig kunskap om sin hälsa. Sjuksköterskan har ett ansvar i att möta det egenvårdsbehov individen har genom att ge egenvårdsstöd för att leva ett mer hälsosamt liv.Background: Chronic kidney disease affects more than every 10th person worldwide. The disease is complex and can be seen with other diseases. Individs need to perform a lifelong and demanding self-management of this progressive disease. In today's health care, one illness is usually cared for at a time, which can cause the care to fail in individualized self-management support. Aim: The aim of this study was to describe experiences of self-management for individs with chronic kidney disease. Methods: A qualitative literature study based on eight empirical articles. The articles were retrieved from the databases PubMed and Cinahl. The content analysis was based on Friberg's five-step model. Results: Two categories and seven subcategories were created based on the result. The two categories were: 1) Health-related values and experiences affect self-management 2) Need for support to perform self-management. Conclusion: The study shows that participants may experience anxiety about their state of health, which makes it difficult to perform self-management. Healthcare needs to have a person-centered approach and take into account the individ's behaviors and values in order to be able to provide individualized information and continuous self-management support. After that, individs can have a good chance of absorbing knowledge about their health. The nurse has a responsibility to meet the individs self-management needs by providing support to live a healthier life.
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Akarkach, Abdelaziz [Verfasser], Max Christoph [Gutachter] Liebau et Hanns Henning [Gutachter] Hagmann. « Long-term peritoneal dialysis in children with autosomal recessive polycystic kidney disease : a comparative cohort study of the international pediatric peritoneal dialysis network registry / Abdelaziz Akarkach ; Gutachter : Max Christoph Liebau, Hanns Henning Hagmann ». Köln : Deutsche Zentralbibliothek für Medizin, 2021. http://d-nb.info/1240617100/34.
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Gonzalez, Jorge Del Pozo. « A study of the aetiology and control of rainbow trout gastroenteritis ». Thesis, University of Stirling, 2009. http://hdl.handle.net/1893/1081.
Texte intégralRésumé :
Disease has been identified as a major problem in the aquaculture industry for the welfare of the fish stocked as well as for its economic impact. The number of diseases affecting cultured fish has increased significantly during recent years with the emergence of several conditions that have added to the overall impact of disease on the industry. Frequently, a lack of scientific knowledge about these diseases is compounded by an absence of effective treatment and control strategies. This has been the case with rainbow trout gastroenteritis (RTGE), an emerging disease of rainbow trout (Oncorhynchus mykiss Walbaum). This study investigated several aspects related to its aetiology and control. A retrospective survey of UK rainbow trout farmers was undertaken to ascertain the extent and severity of RTGE in the UK as well as to identify RTGE risk factors at the site level. Participants in this study accounted for over 85% of UK rainbow trout production in 2004. It was found that the total number of RTGE-affected sites had risen from 2 in the year 2000 to 7 in 2005. The disease was only reported from sites producing more than 200 tonnes of trout/year for the table market. Analysis of risk factors associated with RTGE at the site level showed that this syndrome was associated with large tonnage and rapid production of rainbow trout for the table market. The data collected during this study enabled the identification of those sites that were most likely to present with RTGE the following year and this information was used to study the epidemiology of RTGE at the unit level. A prospective longitudinal study was undertaken in 12 RTGE-affected UK sites. It described in detail the impact, presentation, current control strategies and spread pattern of RTGE within affected UK sites. The risk factors associated with RTGE presence and severity were also investigated. Data were collected for each productive unit (i.e. cage, pond, raceway or tank) on the mortalities, fish origin, site management and environmental factors. RTGE was identified using a case definition based on gross pathological lesions. Analysis of these data revealed that RTGE behaved in an infectious manner. This conclusion was supported by the presence of a pattern typical of a propagating epidemic within affected units. Also, the risk of an unaffected unit becoming RTGE positive was increased if it had received fish from or was contiguous to a RTGE-affected unit. The presentation also suggested an incubation period of 20-25 days. Risk factor analysis identified management and environmental risk factors for RTGE, including high feed input and stressful events, which could be used to generate a list of control strategies. A study of the histopathological and ultrastructural presentation of RTGE was conducted. The location of segmented filamentous bacteria (SFB) and pathological changes found in affected fish were examined. Pyloric caeca were the digestive organ where SFB were found more frequently and in higher numbers, suggesting that this was the best location to detect SFB in RTGE-affected trout. Scanning and transmission electron microscopy revealed a previously undescribed interaction of SFB with the mucosa of distal intestine and pyloric caeca and this included the presence of attachment sites and SFB engulfment by enterocytes, as previously described in other host species. The SFB were not always adjacent to the pathological changes observed in the digestive tract of RTGE-affected trout. Such changes included cytoskeletal damage and osmotic imbalance of enterocytes, with frequent detachment. These observations suggested that if SFB are indeed the cause of RTGE their pathogenesis must involve the production of extracellular products. Analysis of the gross presentation and blood biochemistry in RTGE-affected fish was used to examine the patho-physiologic mechanisms of RTGE. To enable identification of positive RTGE cases for this study, a case definition was created from the information available on RTGE gross presentation in the literature. This case definition was assessed in a sample including 152 fish cases and 152 fish controls from 11 RTGE-affected UK sites, matched by unit of origin. The analysis of these fish using bacteriology, packed cell volume (PCV) and histopathology revealed that RTGE occurred simultaneously with other parasitic and bacterial diseases in a percentage of fish identified with this case definition. With the information gained after analysing the gross presentation, RTGE-affected fish without concurrent disease were selected for the study of the pathogenesis, which included blood biochemical analyses. These analyses revealed a severe osmotic imbalance, and a reduced albumin/globulin ratio suggesting selective loss of albumin, typical for a protein losing enteropathy. The role of the SFB “Candidatus arthromitus” in the aetiology of RTGE was assessed using a newly developed “C. arthromitus”-specific polymerase chain reaction assay (PCR) in conjunction with histological detection. This technique was applied to eight different groups of trout, including an RTGE-affected group and seven negative control groups. This analysis was conducted on DNA extracted from paraffin wax-embedded tissues as well as fresh intestinal contents. The results revealed the presence of “C. arthromitus” DNA in apparently healthy fish from sites where RTGE had never been reported. Additionally, SFB were observed histologically in two trout from an RTGE-free hatchery. These findings do not permit the exclusion of “C. arthromitus” as the aetiological agent for RTGE, although they suggest that the presence of these organisms in the digestive system of healthy trout is not sufficient to cause clinical disease, and therefore other factors are necessary. In conclusion, this study has used a multidisciplinary approach to the study of RTGE which has generated scientific information related to the epidemiology, pathogenesis and aetiology of this syndrome. The results of this project have suggested priority areas where further work is required, including experimental transmission of RTGE, field assessment of the control strategies proposed and further investigation into the aetiology of RTGE.
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Drubay, Damien. « Analyse de la relation dose-réponse pour les risques de mortalité par cancer et par maladie de l'appareil circulatoire chez les mineurs d'uranium ». Thesis, Paris 11, 2015. http://www.theses.fr/2015PA11T008/document.
Texte intégralRésumé :
La relation entre le risque de décès par cancer du poumon et l’exposition au radon est aujourd’hui établie, notamment à partir des études conduites chez les mineurs d’uranium. Mais de nombreuses interrogations persistent sur les risques de cancers extra-pulmonaires et de maladies non-cancéreuses, et sur l'impact sur la santé des autres expositions radiologiques professionnelles. L’objectif général de cette thèse est de contribuer à l’estimation des risques radio-induits aux faibles débits de dose au travers de l'analyse des risques de décès par cancer du rein et par Maladie de l'Appareil Circulatoire (MAC) chez les mineurs d’uranium.Les analyses du risque de décès par cancer du rein ont été réalisées au sein de la cohorte française des mineurs d'uranium (n=5 086 ; période de suivi : 1946-2007), la cohorte post-55 (n=3 377 ; période de suivi : 1957-2007) et la cohorte allemande de la Wismut (n=58 986; période de suivi : 1946-2003) au sein desquelles sont respectivement répertoriés 24, 11 et 174 décès par cancer du rein. L’exposition au radon et à ses descendants à vie courte (exprimée en Working Level Month WLM), aux poussières d’uranium (kBqh.m-3) et aux rayonnements gamma (mSv) a été estimée individuellement et la dose absorbée au rein a été calculée. La relation dose-réponse a été affinée par rapport à l'analyse classique en considérant deux types de réponse : le risque instantané de décès par cancer du rein (analyse classique, Cause-specific Hazard Ratio (CSHR) estimé avec le modèle de Cox) et sa probabilité d'occurrence au cours du suivi (Subdistribution Hazard Ratio (SHR) estimé avec le modèle de Fine & Gray). Un excès de mortalité par cancer du rein était observé dans la cohorte française (SMR = 1,62 IC95%[1,04; 2,41]), mais pas dans la cohorte post-55. Dans la cohorte de la Wismut, un déficit de mortalité par cancer du rein était observé (0,89 [0,78; 0,99]). Pour ces trois populations, aucune relation n'a pu être mise en évidence entre les expositions radiologiques (ou la dose au rein) et le risque de décès par cancer du rein (ex : CSHRWismut_radon/100WLM=1,023 [0,993; 1,053]), ni avec sa probabilité d'occurrence au cours du suivi (ex : SHRWismut_radon /100WLM=1,012 [0,983; 1,042]).L’étude du risque de décès par MAC dans la cohorte française a montré une augmentation significative du risque de décès par MAC (n=442, CSHR/100WLM=1,11 [1,01; 1,22]) et par Maladie CérébroVasculaire (MCeV, n=105, CSHR/100WLM=1,25 [1,09; 1,43]) avec l’exposition au radon. Une enquête cas-témoins nichée au sein de la cohorte a été mise en place pour recueillir dans les dossiers médicaux les facteurs de risque classiques de MAC (surpoids, hypertension, diabète...) pour 313 mineurs (76 décès par MAC (dont 26 par Cardiopathie Ischémique (CI) et 16 par MCeV) et 237 témoins). Pour les trois expositions radiologiques, la relation exposition-risque a été analysée au sein d'une pseudo-cohorte (obtenue en pondérant les observations par l'inverse de la probabilité de sélection, n=1 644 pseudo-individus) avec le modèle de Cox, en ajustant sur les différents facteurs de risque. L’association entre les expositions radiologiques et le risque de décès par MAC, CI ou MCeV n'était pas significative (ex : CSHRMAC_radon/100WLM=1,43 [0,71; 2,87]). La prise en compte des facteurs de risque ne modifiait pas sensiblement cette association.L'absence de relation dose-réponse significative suggère que l'excès de mortalité par cancer du rein chez les mineurs français serait induit par d'autres facteurs, non-disponibles pour cette analyse. La faible variation des coefficients avec l'ajustement sur les facteurs de risque de MAC dans l'enquête cas-témoins nichée soutient l'hypothèse de l'existence d'une augmentation du risque de MCeV dans la cohorte française associée à l’exposition au radon. La poursuite du suivi de la cohorte permettra d'affiner ces résultatsThe relation between lung cancer risk and radon exposure has been clearly established, especially from the studies on uranium miner cohorts. But the association between radon exposure and extrapulmonary cancers and non-cancer diseases remains not well known. Moreover, the health risks associated with the other mining-related ionizing radiation exposures are still under consideration. The aim of this thesis is to contribute to the estimation of the radio-induced health risks at low-doses through the analysis of the kidney cancer and Circulatory System Disease (CSD) mortality risks among uranium miners.Kidney cancer mortality risk analyses were performed from the French cohort of uranium miners (n=5086; follow-up period: 1946-2007), the post-55 cohort (n=3,377; follow-up period: 1957-2007) and the German cohort of the Wismut (n=58,986; follow-up period: 1946-2003) which included 24, 11 and 174 deaths from kidney cancer, respectively. The exposures to radon and its short-lived progeny (expressed in Working Level Month WLM), to uranium ore dust (kBqh.m-3) and to external gamma rays (mSv) were estimated for each miners and the equivalent kidney dose was calculated. The dose-response relation was refined considering two responses: the instantaneous risk of kidney cancer mortality (corresponding to the classical analysis, Cause-specific Hazard Ratio (CSHR) estimated with the Cox model) and its occurrence probability during the follow-up (Subdistribution Hazard Ratio (SHR) estimated with the Fine & Gray model). An excess of kidney cancer mortality was observed only in the French cohort (SMR = 1.62 CI95%[1.04; 2.41]). In the Wismut cohort, a decrease of the kidney cancer mortality was observed (0.89 [0.78; 0.99]). For these three cohorts, the occupational radiological exposures (or the equivalent kidney dose) were significantly associated neither with the risk of kidney cancer mortality (e.g. CSHRWismut_radon/100WLM=1.023 [0.993; 1.053]), nor with its occurrence probability during the follow-up (e.g. SHRWismut_radon /100WLM=1.012 [0.983; 1.042]).CSD mortality risk analyses in the French cohort showed a significant increase of the risks of mortality from CSD (n=442, CSHR/100WLM=1.11 [1.01; 1.22]) and from CerebroVascular Disease (MCeV, n=105, CSHR/100WLM=1.25 [1.09; 1.43]) with radon exposure. A case-control study nested in the French cohort was set up to collect the information related to CSD risk factors (overweight, hypertension, diabetes...) from the medical records of 313 miners (76 deaths from CSD (including 26 from Ischemic Heart Disease (IHD) and 16 from MCeV) and 237 controls). For the three radiological exposures, the exposure-risk relation was analyzed in a pseudo-cohort (n=1,644 pseudo-individuals, obtained from the weighting of the observations by their inverse selection probability) with the Cox model, adjusted for the CSD risk factors. The association between the radiological exposure and the risk of mortality from CSD, IHD or MCeV was not significant (e.g. CSHRCSD_radon/100WLM=1.43 [0.71; 2.87]). The adjustment for CSD risk factors did not substantially change the exposure-risk relation.The lack of a significant dose-response relation suggests that the excess of kidney cancer mortality among the French uranium miners may be induced by other risk factors, unavailable for this study. The small change of the coefficients observed after adjustment for CSD risk factors in the nested case-control study supports the assumption of the existence of the MCeV mortality risk increase associated with radon exposure in the French cohort of uranium miners. Future analyses based on further follow-up updates should allow to confirm or not these results
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CHUANG, TZUNG-FANG, et 莊宗芳. « Risk of Chronic Kidney Disease in Patients with Kidney Stones -A Nationwide Cohort Study ». Thesis, 2017. http://ndltd.ncl.edu.tw/handle/06627766070488813033.
Texte intégralRésumé :
碩士中臺科技大學
醫療暨健康產業管理系碩士班
105
Background: Chronic kidney disease and kidney stones in Taiwan are common diseases, especially chronic kidney disease, with a high prevalence but low rate of self-awareness. Chronic kidney disease-related risk factors such as diabetes, hypertension, and nephrotoxic drugs are clear and uncontested, kidney stones is relatively less mentioned and easily overlooked as a risk factor. CKD is a recognized complication of kidney stones, in some rare hereditary disorders(e.g., primary hyperoxaluria, Dent disease, cystinuria), due to their early onset, and the urine in a high concentration of calcium or high concentrations of oxalic acid state for a long time, acid-base abnormalities, or supersaturated crystal, resulting in repeated urolithiasis and further causing kidney damage. However, it is unknown whether kidney stones are an important risk factor for CKD in the general population. Methods: We conducted a nationwide population-based matched cohort study to assess the risk of incident CKD in people with kidney stones. The data for this study was from the Taiwan’s National Health Insurance database. From the database we captured incident stones formers in the year 2001 excluding past history of CKD as stones cohort. Stone formers were matched 1:4 to control subjects according to sex, age and the index date. With the total observation period of 10 years, the primary end point was the occurrence of CKD. The Student’s t-test and Chi-squared test were used to compare continuous and categorical data, respectively. Logistic regression was used to calculate the odds ratio (OR) of patients with kidney stones with incident chronic kidney disease compared to the control group. The Cox proportional hazard regression model was proceeded to obtain the HRs for development of incident CKD among patients with kidney stones. Results: During the ten years of observation, 4170 people were suffering from chronic kidney disease at a rate of 11.2%, significantly higher than the control group (6.2%). There was a significant difference in chi-square test (p <0.001). The binary Logistic regression showed that the stone formers had a higher risk of getting chronic kidney disease (OR: 1.94; p <0.001) after adjustment for potential confounders including age, gender, comorbidities (hypertension, diabetes, hyperlipidemia and cardiovascular disease). Cox proportional hazards regression models adjusted for age, gender, and comorbidities were used to assess the risk for incident CKD within stone formers (HR=1.815, <0.001). Conclusions: Kidney stones are a definite risk factor for chronic kidney disease. Patients with stones are suggested to undergo regular renal function monitoring and receive appropriate treatment to avoid the formation of chronic kidney disease.
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Huang, Bo-Ruei, et 黃柏瑞. « An Association Study ofChronic Kidney Disease and Water Quality ». Thesis, 2016. http://ndltd.ncl.edu.tw/handle/42098249379156657306.
Texte intégralRésumé :
碩士國立臺灣海洋大學
資訊工程學系
105
Chronic kidney disease prevails among various countries . Medical expenses have become a great burden. The prevalence of chronic kidney disease in Taiwan is the highest in the world. Thus, identifying risk factors for chronic kidney disease is important. The aim of this study was to examine the relationship between chronic kidney disease and water quality in Taiwan using the correlation values. We got the kidney disease prevalence and the water quality data to study their correlation. Our results showed that arsenic in groundwater and nitrate nitrogen in reservoir and chemical oxygen demand in river were potential risk factors for chronic kidney disease. The arsenic in groundwater is the most significant item. The correlation coefficient between arsenic and chronic kidney disease is 0.60. The correlation coefficient between arsenic and end-stage renal disease even reached 0.72. For our suspected risk factors, we want to know whether there are more papers have proven their impact on chronic kidney disease, and some have proven their relevance, some of them are also need to invest more research to observe the relevance. But no matter what, if we let the public to reduce the contact to the water region which is including the above monitored items, we believe that Taiwan can effectively reduce the incidence of kidney disease.
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Kuo, Hsin-Wei, et 郭馨蔚. « The epidemiologic study of chronic kidney disease in Taiwan ». Thesis, 2007. http://ndltd.ncl.edu.tw/handle/58666634791002263493.
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Su, Meiwen, et 蘇美文. « The Study On Medical Utilization Among Chronic Kidney Disease Patients ». Thesis, 2012. http://ndltd.ncl.edu.tw/handle/35551779606852574041.
Texte intégralRésumé :
碩士義守大學
管理學院管理碩士在職專班
100
Because the early symptoms of chronic kidney disease（CKD） is not apparent, patients will try herbal treatment in an attempt to rescue the irreversible loss of kidney function and avoid future dialysis. Therefore, the purpose of this study was to examine CKD patients whose renal function was abnormal ,they would take western medicine doctor advices and had to seek medical treatment patterns and choices. A retrospective study of the description, a primary joint clinics in Pingtung area 60 mining conception samples in patients with chronic kidney, to make half-depth of structured questionnaires conducted face to face interviews, according to the purpose of this research and study on structure, developing semi-structured questionnaires completed first draft, followed by six expert validity. To test the reliability of the questionnaire, test the consistency reliability, as the formal basis of the questionnaire. For 101 years during research filed March 19, effective filed on 50 patients with chronic kidney disease. Chronic kidney disease patient men and women of the 25 people, with majority system diseases as diabetes. Just know when kidney dysfunction, had taken treatment patterns is still mostly a folk remedies remedy. Most people do not know is the current Government has actively focused on prevention and treatment of kidney disease. This study found that patients in an attempt to cure and recovery of renal function, and folk remedies of Western medicine therapy is to help non-Orthodox. Medical staff have the necessary prevention and education advocacy, strengthening the counselling of patients medical history and medical type, with a view to reducing the incidence of chronic kidney disease.
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Ji, Ching-Shien, et 計慶賢. « The Longitudinal Study on Early Chronic Kidney Disease in Navy ». Thesis, 2014. http://ndltd.ncl.edu.tw/handle/25370748557277545012.
Texte intégralRésumé :
碩士國防醫學院
公共衛生學研究所
102
Chronic kidney disease (CKD) is one of the predominant epidemic diseases in the world.The increasing prevalence and incidence of CKD also meet to the critical problem in medical cost.Because of the stressful environment, aircrews, who have a high risk of renal dysfunction.It would be a better strategy in preventing the CKD from bad to worse is to diagnose in early stage. In order to achieve this objective, we investigate the prevalence of CKD status, risk factors and long-term trends. In this longitudinal study, we elected the 246 Subjects who had participated medical examinations in military hospital since 2009 to 2013, and can be tracked 4 years. By the using aMDRD formula to estimate the glomerular filtration rate, in addition, combine with the NKF-K/DOQI to decide the CKD patients. In these results, the prevalence of CKD was 7.7%, 2.8%, 5.3%, 9.3% for four years. In logistic regression analysis,high blood pressure, total cholesterol abnormalities and urinary occult blood positive, will increase the risk of CKD. GOT, urea nitrogen, urine specific gravity and high blood pressure can predict future risk of CKD. In this study, the prevalence and incidence of CKD showed a rising trend in the annual. Most of our patients are belong to early stage. In the future, we can focus on not only annual physical examine, but also identify persons at high risk. Furthermore, use of health information system to management over the years aircrew examination results, and strengthen the effectiveness of medical management in Navy.
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Weng, Chien-Chih, et 翁健智. « A Study of Kidney Disease Determinant Factors for Taiwan Elderly ». Thesis, 2013. http://ndltd.ncl.edu.tw/handle/63875711306556073252.
Texte intégralRésumé :
碩士輔仁大學
統計資訊學系應用統計碩士班
101
The purpose of this study was to confirm the correlation among health status, health behaviors and kidney disease for elderly in Taiwan and the interference effect of personal backgrounds. Data in this study came from individuals, aged 65 and above listed in 2005 Taiwan National Health Interview Survey Database (NHISD). The variables included personal backgrounds, health status, health behaviors and kidney disease. After the data were analyzed via frequency distribution, descriptive statistics, cluster analysis, association analysis, Chi-square Automatic Interaction Detection (CHAID) and Classification and Regression Trees (CART), the results are as followed：hypertension, diabetes, heart disease, gout, the number of the location of the pain and the number of species of health food is the impact of the main factors of the elderly suffering from kidney disease. Personal backgrounds will moderate the impacts between health status and health behaviors on kidney disease. Regardless of their backgrounds, the impact of health status is much greater than that of health behaviors.