Genetic link indicating susceptibility to glomerulonephritis

It is well known that kidney disease affects people from some backgrounds more than others. And a recent report has now identified key genes which show a susceptibility to the kidney disease Immunoglobulin A Nephropathy (sometimes shortened IgAN). The article is currently available in the advanced on line issue of Nature Genetics, but will eventually appear in the next print edition of this respected scientific journal.

IgAN is a kidney disease where Immunoglobulin A gets deposited in the glomeruli, leading to glomerulonephritis, leading to kidney damage, and is the commonest cause of renal failure among Asian people. Up to 40% of sufferers require dialysis or transplants. The genetic trends can be spotted by the distribution of the disease - in Asian populations it can be as high as 3.7%, while amongst Caucasians it is 1.3% but among African groups it is quite rare.

A team of 25 medics and scientists from Singapore and China, working at 14 hospitals and research centers studied literally thousands of individuals of Han Chinese origins, and identified variants of genes which occurred in patients with IgAN. This research can help provide new insights on the pathways involved in the cause of the disease, and by identifying susceptible individuals provide opportunities to prevent them developing serious kidney damage.

This is not the first study to suggest there is a genetic link causing IgAN. Earlier work from 2003 by a large group of Japanese medics and scientists examined several hundred Japanese patients, and found faults in one of the genes in many cases. They suggested the approximate location of a gene which resulted in IgAN in Japanese patients.

Illegal Kidney Trading

We sometimes see this sort of thing in movies and tv programs, but many of us think it is just some plot line to make a show around. Wrong.

Two news items caught my eye today, one from Viet Nam, the other from Pakistan, both dated 25th November.

The story from Viet Nam involved a trader ring, who persuade others to cross the border to China and sell one of their kidneys.

Two of the gang members got started after selling their own kidneys, then got involved in transporting others to the kidney dealers in China. According to the court's verdict, from 2008 to February this year, the four members of the ring who have been sentenced to prison took 19 poor Vietnamese nationals from HCM City and southern provinces to China to sell their kidneys.

The second story came from Pakistan, The people come from rural areas like Yazman in Bahawalpur district, one of the areas that is carrying out this practice. Bahawalpur police said that last year 30 confirmed cases have been reported..

So I had a google around on this topic.

The same source of the above Pakistan news item reported, on 11th November, about an illegal kidney transplant centre run by a senior surgeon of the Lahore General Hospital.

And then I found a report of one man from Belarus, who spent a month locked up, waiting for the surgeon to come to remove his kidney to be implanted in an Israeli woman. He had replied to an advert offering good money to those willing to donate their organs. He received threats to his family if he spoke about his ordeal.

And finally, I came across an article which claimed that African refugees were captured by Bedouin tribes to have their organs transplanted. Here, it claimed, after harvesting the organs, the victims were left to die and dumped in an old well. (It also said several organs were removed, not just kidneys). Mobile clinics come from a private hospital in Cairo to an area in the deserts of Mid-Sinai and conduct physicals on the Africans before they choose those suitable, then they conduct the operation.

More worryingly, the doctors who are often involved in this trade have not seen any threat by the concerned authorities. Usually it's the middle men that get caught. Organ sales are, of course, banned across the globe.

I should point out that ALL these reports are dated this month.

DaVita buys another company

DaVita is the second biggest dialysis company in the US where it runs a large number of dialysis centers. It has operations in Singapore and Bangalore as well, and is looking at China as a future market. But is also has plans for Europe, where it already has a subsidiary.

It was reported recently in the Denver Post that DaVita has acquired a German dialysis company, ExtraCorp AG, a company that owns two dialysis centers, in Salzgitter and Seesen, and manages two others, in Dresden and Freital. And Davita is on the lookout for more European business. Perhaps because their is little room left for much growth in the US dialysis market.

Diabetes Mellitus Takes Its Toll

A recent study of patients with diabetes mellitus showed that the risk of developing chronic kidney disease rises with multiple episodes of acute kidney injury during hospital stays for patients with diabetes. Acute kidney injury is common in hospitalized patients, and the research showed that over half of them required at least one hospitalization during the follow up period, and 30% of those had at least one episode of acute kidney injury during their time in hospital. As diabetes is a major factor in kidney failure, suffering episodes like this while in hospital increases the risk of eventual failure. Preventing these problems occurring could help reduce problems later in life.

Texas Hold 'Em Benefit

In a dialysis blog you might be a bit surprised by this post's title, so let me explain.

Alport Syndrome Hope for Cure Foundation will be the recipient of funds raised at the 3rd Annual Texas Hold 'Em Tournament held on 11th November at the Gleneagles Country Club in Plano, Dallas.

The goal is to raise money to run a scientific research meeting into Alport Syndrome, a rare kidney disease, affecting mainly boys. While some people may go to the tournament to win prizes, and plenty are on offer, just remember that, like many events, there is also a caring side and children may benefit for the event.

Jonah Lomu - Update

There have been several more news items on the Rugby star's condition.

He is reported as recovering and still on regular dialysis, but has been given a slim chance of a "normal" life.

He has withdrawn from the charity boxing match mentioned in the previous article.

PS If you want to see what he was like as a player, just watch this compilation of him in action. There are many shots where he fends off three or more blockers simultaneously to get a touchdown. I noticed a couple of times when five blockers failed to stop his run; be amazed at his power.

New Zealand Rubgy Hero Jonah Lumo in Kidney Drama

Jonah Lumo, the New Zealand Rugby legend, had another kidney scare recently, but was discharged from hospital a few days ago.

At his peak, Lumo was a true legend in rubgy and was responsible for many of new Zealand's international wins in the late 1990s. He played in 63 rugby Test Matches and two World cups. Yet one year after his début on the international scene in 1995 he was diagnosed with nephrotic kidney syndrome. This did not stop him from becoming one of the sport's start attractions and he had a very dynamic presence on the field. In 2004 he had a kidney transplant from broadcaster Grant Kereama, which initially seemed very successful. His kidney problems raised the profile of kidney diseases in general, especially in New Zealand.

Recently he decided to take part in a charity boxing event, Fight for Life, in Auckland, New Zealand, on December 3 2011, and has been in serious training for the event. Several other big sports stars are also taking part. Asked about the risks of boxing, he was quoted in another kidney blog as saying "There's no difference between this and playing rugby. Life is too short to be wrapped up in cotton wool." (See footnote). A fantastic attitude to take for someone who has had a transplant.

Then on September 24 2011, Jonah was admitted to hospital with severe kidney problems as his transplanted kidney seemed to be failing. Attempts have been made to repair any problems with the kidney, but doctors fear that he may need a second transplant and that his kidney is liable to fail well short of the expected 20 year life they initially thought it should have.

Since then, Jonah has been on dialysis, and been treated with drugs in an attempt to save the kidney but was released from hospital on October 11. The drug treatment and the kidney problems have had a huge knock on effect on the rest of his body, he is suffering bouts of tiredness and nausea, and it is not clear whether he will take part in the boxing match (unlikely, we'd say), as his immune system is somewhat depressed due to the drugs being used to prevent rejection of his transplanted kidney. It is also not clear whether he will eventually have a second transplant.

Footnote: For our American readers, rugby is a British game, very much like American football ( in fact that's where your football came from).
Except there is a lack of body armour, and the team doesn't change players every five minutes, they stay on the field for the entire game.
It's a game for HARD men.

Flu and the dialysis patient

As winter comes closer and closer, it's time for dialysis patients to think about flu and vaccinations. For most people flu is a problem but just like any other illness. For those on dialysis with CKD, it's a bit more serious and can result in pneumonia and other equally serious problems. It really is worth speaking to your doctor and dialysis specialist about getting vaccinated. Fresenius in North America are offering an annual flu vaccination to all their patients. Don't miss out on this. Ask your doctor's advice and reduce the risk of problems in the coming months from the seasonal rise in flu.

Longer intervals between dialysis not good

We noticed this news item popping up in many news sites, based on a recent research article in the New England Journal of Medicine.

The doctors involved looked at a large number of patients (32,065 to be exact) from the End Stage Renal Disease Clinical Performance Measures Project - a project that gives a representative sample of patients on hemodialysis three times a week. They found that there was an increased risk of heart problems and a low tolerance of metabolic deviations from the normal range.

They suggest that with three day a week dialysis - eg Monday, Wednesday, Friday - the longer gap between the Friday and Monday treatments may be a bit too long. Evidence showed that death rates and hospital admittance rates were higher on the day after the two day gap than at other times. This suggests that the higher level of accumulated toxins at that point in the treatment may be causing these patients problems.

Dialysis patients and their family should perhaps be on the look out for problems and poorer health at the longer gap point in their weekly schedule.

Inverness Dialysis Patient's Canoe Trip

Martin MacRae doesn't think dialysis should tie him to a sick bed, so he has decided to show the freedom gained from his new portable dialysis machine and canoe the breadth of Scotland via the Caledonian Canal. He will be camping at a series of rest points during his six day trip and will have his dialysis each evening for three hours - in his tent!

There are only two of these small units available in Scotland on the NHS, while there are around 70 in England, and thousands in the USA. So Martin is hoping that the sponsorship he has attracted will raise money to purchase more for the renal unit at Raigmore Hospital, Inverness.

Why not support Martin in his venture, by going to Just give to Martin MacRae and donating something, anything.

And wouldn't it be a nice gesture the unit's manufacturers donated a machine... (Hint, HINT, Very Strong Hint)

This was first spotted on the BBC News page on the 30th August, 2011, and an update in the Inverness Courier the next day reported that he successfully completed the first stage. So hurry up and donate!

AWAK testing a portable dialysis unit

The Singapore company Awak Technologies Pte. Ltd. are currently testing a portable peritoneal dialysis unit. There have been many reports of such devices over the last two or three years, but this one looks a bit further along the road than most. The unit has a pump and battery which are connected to a dialysate pack. The video below gives an explanation of the devices (there will be a short advert first however), and you can read more at The Wall Street Journal or at AWAK's own web site.



The spent dialysate is continuously regenerated from the AWAK unit and reused in perpetuity. This is a bit different to normal peritoneal dialysis, where the entire dialysate is replace and the spent solution discarded

It is currently undergoing animal testing in Singapore, in preparation for clinical testing in the U.S., Germany and Singapore.

The company has won an innovation award for their work on this device.

This could be a real bonus for some dialysis patients, giving them much more freedom as they can continuously "top up" on their treatment more conveniently than with standard peritoneal dialysis.

Questions about the safety of Epogen and doses given

Epogen reduces the need for blood transfusions among dialysis patients, and counters the fatigue from long sessions. It's been in production since 1989.

But according to this news report (22 July, 2011), new guidelines have questioned the safety of this and related drugs. According to the report at Vcstar.com, "the FDA finally announced on June 24 new guidelines that are projected to slash the U.S. clinical use of Epogen by as much as a third. The FDA cited the increased risk of cardiovascular events ranging from stroke to death."

Links to the FDA's reports can be read on line and in more detail here (27 June 2011).

The FDA now requires a warning label about risks because of data showing increased risks of cardiovascular events with ESAs. The manufacturers have revised their labelling and on line information about the drug.

Diet that reversed kidney failure in diabetic mice

We missed this report when it came out, but thought it worth including.

A BBC News report covers some research where diabetic mice were fed a diet high in fat and low in carbohydrate. And damage to the kidneys caused by too much sugar was reversed.

The researchers at the Mount Sinai School of Medicine in New York used mice with both type 1 and type 2 diabetes.

Once kidney damage had developed, half the mice were put onto the ketogenic diet for eight weeks.

The highly controlled diet, which is 87% fat, mimics the effect of starvation and should not be used without medical advice. After eight weeks the researchers noted that kidney damage was reversed.

It is also questionable whether the diet used in this model would be sustainable for humans, even in the short term.”

The researchers also need to figure out the exact process that leads to repair.

Dr Iain Frame, director of research at Diabetes UK, said: "This research was carried out in mice so it is difficult to see how these results would translate into any real benefits for people with diabetes at this stage.

As diabetes is a major factor in causing kidney damage and leading to dialysis, IF this could be translated in to something that was usable in humans, it could lead to a major improvement for diabetics.

Australian Problems with Dialysis

Here we highlight two recent news articles about Australia, for a change.

The first report claims that "kidney disease is rampant in the Northern Territories".

The basis for this claim is new figures showing that end-stage kidney disease in NT is approximately three times that of the rest of Australia. The figures are due to the higher proportion of Aboriginal people living in that area, and Aboriginals are one of the groups who generally suffer much more from kidney problems. Often due to diabetes and the associated kidney damage.

Reported by ABC.Net and Topnews.

The second report says that "Aborigines are choosing to die rather than travel for dialysis" - another dramatic headline.

This report opens with a statement that Aborigines (or indigenous Australians for the politically correct among you) are eight times more likely to die from chronic kidney disease than other Australians. The reason is claimed to be that the lack of nearby dialysis services forces people to travel long distances for treatment, and many do not like this. Especially as South Australia was refusing to fund interstate dialysis treatments for people living in remote areas of the state.

We read this article at The Australian.

Let's hope this dreadful state of affairs is eventually improved.

Vytorin Lowers Heart Disease Risk in Kidney Patients

Vytorin, a drug used for lowering cholesterol levels, has been found to reduce the risk of heart disease among kidney patients by up to 25 percent, according to the results obtained by Oxford University research scientists who carried out the research on a group of 9,270 kidney disease patients, with the work starting in 2003.

The measured improvement was 17% but many patients were not on the drug for the entire test period, and the researchers estimate that the improvement would have been 25% if they had.

Patients with chronic kidney disease are at high risk of suffering a heart attack. Lowering the LDL levels (the so-called bad cholesterol) reduces the risks for healthy people, but this latest study shows it works very well for chronic kidney disease patients too, reports Dr. Colin Baigent of Oxford University, in the June 9th online version of The Lancet

Vytorin is a low statin drug (statins are not processed well by kidney patients) combined with Zetia (ezetimibe). The research was funded in part by the drug's manufacturer, Merck/Schering-Plough Pharmaceuticals.

While this will not cure any kidney disease, it reduces the problem of death from a secondary cause. Given that it is estimated that 10% of people have some form of kidney disease, the research is considered to have major implications in improcing health and life-span.

Dialysis doesn't stop Ironman Triathelete

Some people might imagine that if you are on dialysis you are some sort of a weak and fragile person. They obviously forgot to tell Shad Ireland this!

He is taking part in the Amgen Tour of California, despite being on dialysis. His training included cycling in the snowy weather around Lake Tahoe, while everyone else was looking for excuses not to. Shad has launched a 24-month project called Taking on the Tour, an effort to educate and inspire support for kidney dialysis patients world wide.

His schedule included riding stages two, four and six of the Amgen Tour of California as well as stages in July's Tour de France and August's Tour of Utah — riding the routes non-competitively.

Ireland, from Buford, Ga., is also the only dialysis patient to complete the grueling Ironman triathlon multiple times; also riding across the country in 2009 from California to Washington, D.C., for dialysis awareness.

He hasn't had it easy however. Told he would need dialysis when only 10 years old, his doctors then told him when he was 16 that he wouldn't make it past 25. He's now 39. Stubborn, eh?

We read this inspiring report in several places, such as here.

Also look out for the Shad Ireland Foundation too.

Keryx says more European drug trials not necessary

Keryx Biopharmaceuticals says that it does not believe that it will need to carry out more tests so that its kidney drug Zerenex (ferric citrate) will be approved in Europe. This was reported on several news sites.

The drug is used to treat high phosphate levels (hyperphosphatemia) in patients with chronic kidney disease as well as those on dialysis. The drug is already licensed in many other markets, apart from some Asian areas.

Volunteers for trials were recruited around October 2010. A report in December 2010 said that it successfully reduced phosphate levels.

Find a Kidney Donor - using Facebook!

I'm not the world's greatest fan of Facebook, but it does have its uses. It's claimed to bring together old friends and classmates, but in the case of Tim Magsby, who had been on dialysis for four years, it did a bit more than that!

After four years worrying, with no close relatives suitable as a donor for a kidney, he turned in desperation to Facebook, and posted a video asking for help. Then an old school mate saw the video on a mutual friend's page and contacted Tim, even though they hadn't spoken to each other for 25 years. Tim was worried that it might be a joke, but Randy Riney, on thr left in the image, had the same blood type as Tim, on the right below, and the surgery was successful.

Original Story is here.

Taking Statin before Major Surgery can reduce your risk of kidney problems

Many patients who undergo major elective surgery can develop kidney problems after surgery, due to decreased blood flow to the kidneys during the operation, or due to inflammation.

In a research paper to be published in the Journal of the American Society of Nephrology, researchers claim that taking a statin before surgery could protect the kidneys from being damaged. They examined the medical records of a large number of older patients in Ontario who underwent surgery between 1995 and 2008, and saw that those who were taking statins were 20% less likely to develop problems.

A total of 213,347 patients from 211 hospitals underwent major elective surgery, and 4,020 patients (1.9 per cent) developed postoperative kidney injury within two weeks of surgery. Of these, 1173 needed dialysis within 14 days of surgery, and a shocking 5,974 died with a month of their operations.

Home Dialysis May Ease Restless Legs Syndome

A recent report suggests that switching from treatment at a dialysis centre to treatment at home could be a solution to the lack of sleep problem encountered by some dialysis patients due to restless legs syndrome.

If you suffer from pins and needles or creepy-crawly feelings in your legs, then you may be suffering from restless leg syndrome; and if you are a dialysis patient, then you are about four times more likely to have this problem, and end up with sleepless nights. The patient is kept awake due to the legs twitching.

The continual sitting for prolonged periods during clinic based dialysis is one possible reason for dialysis patients suffering from this problem.

An investigation of patients who had home dialysis for a few hours each day showed improvements in restless leg syndrome and a lasting improvement in other sleep problems such as insomnia and daytime sleepiness.

Are Dialysis Patients X-rays a Risk?

A recent report from Italian researchers suggests that regularly x-raying dialysis patients to monitor their health is itself a health risk.

Marco Brambilla of Maggiore della Carità University Hospital in Novara, Italy said that the majority of routine x-rays to monitor a dialysis patients health gave no useful information. But the overall result for some patients was being exposed to the equivalent of 1000 chest scans a year! They followed 106 Italian dialysis patients' medical records over a three year period to come to this conclusion.

Many patients under went CAT scans (Computer Axial Tomography, to produce a 3-d image) and these can result in a dose of x-rays up to 100 times that of a standard x-ray. It was suggested that CAT scans are sometimes done without considering the cumulative risk or checking what other x-rays may have been given.

One of the problems is that increased exposure to x-rays is considered to be a cancer risk, and unless the process is properly recorded and monitored, the dose received over a long period of time can be quite high. The number of x-rays given while monitoring a patient's health varies from country to country, and some can be related to other health problems that a kidney failure patient may suffer. An earlier study (no reference available at present) suggested that about 2% of all cancers in the United States were caused by exposure to radiation during CAT scans.

One way to support your team!

This story has appeared in literally hundreds of places, and I thought I might as well mention it too.

Tom Walter is the baseball coach for Wake Forest.
Wake Forest signed new hopeful Kevin Jordan last year
- nothing unusual so far.

Two months after this Jordan developed a serious kidney problem, which resulted in him needing regular dialysis. Jordan learned last April that he had ANCA vasculitis, an autoimmune swelling disorder caused by abnormal antibodies, and wound up on dialysis. The antibodies can cause blood and protein to leak into the urine and could result in kidney failure. And unfortunately his relatives were not a good match for a transplant.

Now the interesting bit - his coach Walter turned out to be a match for a kidney transplant to the new signing. So the coach decided to donate a kidney, and the transplant was carried out on 8th February. Both are said to be recovering normally.

Now I've heard of fans having a tattoo with their team's star player's name on it or something similar (which can be a bit of a problem if they sign for some other team a year or two later), or wearing shirts with the star's name on it (less of a problem if they leave the team). But giving a kidney to a player is a bit exceptional. So exceptional that I found 466 news pages mentioning this act of generosity!

You have to admire the man for doing this, of that there is no doubt.

I wonder if the coach would ask for it back if Jordan one day signed for another team...

Home dialysis viable following kidney transplant failure

Reported in DailyHealthReport, and many other sites.

Many patients who have a transplant end up returning to dialysis. The statistics show that there is very little survivability differences for such patients when using home dialysis compared to using hospital dialysis. There have been many studies on the survivability rate for the two treatments, and all report this same result. But, according to the Clinical Journal of the American Society Nephrology, less than 20% of those returning to dialysis choose home dialysis. Home dialysis is a huge cost saver, and empowers the patients, freeing them from the tedium of continual visits to a clinic.

This latest research was carried out by doctors at St. Micheal's Hospital, University of Toronto.

Interestingly, while there is an increase in the number of patients receiving dialysis, the number on home dialysis is decreasing.

Donate your kidney and get out of jail

Reported by the BBC News and other news sites.

Two sisters jailed for an armed robbery that netted them a total of $11 / £7 have just been released on the condition that one donates a kidney to the other. Jamie Scott's daily dialysis costs the state roughly $200,000 / £129,000 per year.

They received a life sentence for an armed robbery in 1993 (but of course the news report only mentions the bare minimum of details to make it look an unjust sentence). The report mentions that protesters marched through the state capital last year, calling for their release and claiming that the sentences were harsh.

Prison officials are reported to have said that they no longer think the sisters, who are eligible for parole in 2014, are a threat to society. Obviously the saving in dialysis costs had no bearing on their release...

KDN - Greatest Hits 2010

One of the things that I personally don't like about basic blogging software is the way good articles can slip down out of sight, forcing the visitor to search through month by month to see what else has been covered on a blog. While reading a techy advice blog, I found they suggested an idea that I'd been considering myself - a greatest hits list. This would be a summary of earlier articles that had proved popular over the last year, giving visitors an easy way to catch up on what they'd missed.

So here are our most viewed articles, with normalised viewing figures instead of the actual views - that means I've given the most viewed one 100%, and compared the others with that article's views. It was going to be a Top Five list, but three articles were very close in the number of views, to I made it a Top Seven instead.

Portable dialysis machine Dec 2009 - 100%
This topic in general seems to have quite a few web pages devoted to different designs, but this particular design seemed to crop up quite often in Google.

Implantable Artificial Kidney - coming soon Sept 2010 - 84%
Although this is a recent article, it has grabbed second place due to the huge amount of interest such a device has created and how useful it would be. Let's hope its future is as bright as its developers hope.

Vitamin E helps fight muscle cramps during dialysis Nov 2009 - 78%
With around 20% of patients suffering from cramp during dialysis, this article attracted a fair bit of attention.

Fresenius gets another warning Oct 2010 - 66%
Their claimed failure to deal properly with problem items already out in the field generated some bad publicity for this well-known supplier.

Drug hope for Polycystic Kidney Disease Sufferers Sept 2010 - 57%
I suppose any good news about a new drug showing hope automatically attracts attention.

Location, location, location July 2010 - 56%
This article showed that where you lived had a big effect on how well you were treated. There were two such articles in short succession (one about the US and the other about the UK), and the link shows both of them.

Baxter Recalls Peritoneal Dialysis Solutions Dec 2010 - 55%
Another big supplier has problems with its products. For such a recent article to feature in the top seven shows that patients are trying to keep up to date on these product recall stories.

So if you've missed them, give these articles a read.