Kidney News Tion Is Linked to Health Benefits, Especially Come End Points

August 2013 | Vol. 5, Number 8 The IOM on Salt—Is Too Little the Same as Too Much? Inside By Kurtis Pivert Worth its salt? Medicine (IOM) analysis—Sodium Intake cluded literature using surrogate markers, A recent IOM report questions in Populations: Assessment of Evidence—has namely blood pressure, concentrating in- the need for establishing salt ignited a debate about whether salt restric- stead on studies using direct health out- intake levels. Kidney News tion is linked to health benefits, especially come end points. Yet the relevance of this provides a thorough look at for at-risk individuals (1). evidence has been questioned over uncon- the issue. Recent studies selected by the IOM ventional clinical approaches or methodo- offered inconsistent or insufficient evi- logical limitations. Because of the conten- Renal Imaging dence that a daily sodium intake of 1500 tious reaction, the authors felt it necessary Imaging kidneys at the mg (for certain patient subgroups) or to clarify their findings in a recent JAMA molecular level holds promise 2300 mg (for the general population) article (2). for less invasive procedures reduced the risks of cardiovascular dis- Although affirming the association be- and improved accuracy. ease or premature mortality. tween higher sodium intake and increased The IOM also concluded that a two- cardiovascular risk, the report’s remaining tiered approach to sodium intake—one conclusions conflict with current dietary Journal View recommended level for patient subgroups guidelines and contradict the IOM’s pre- Could a test for a “three- and another for the general population— vious recommendations on sodium and gene signature” detect acute was not warranted. Patient subgroups health (3,4). Its publication comes as rejection of kidney allografts included those 51 years or older, African Americans’ addiction to salt remains un- before diagnosis by biopsy? Americans, and individuals with kidney or diminished, with average consumption cardiovascular disease, diabetes, or hyper- holding steady at 3400 mg/day in spite tension. of multiple initiatives to reduce excessive Policy Update new report on sodium and health Discussion has centered on the narrow intake. Major proposed cuts to the found recent evidence is insuffi- focus stipulated by the Centers for Disease To understand the controversy sur- ESRD program rally the kidney A cient to support recommended Control and Prevention (CDC), which rounding the IOM’s findings, ASN Kidney community: physician payment dietary intake levels. The Institute of commissioned the review. The IOM ex- Continued on page 5 models and sustainable growth rate make the news Ultrasound Therapy May Help Prevent and Treat Acute Kidney Injury By Tracy Hampton cute kidney injury is one of the Mark Okusa, MD, of the University of in the Journal of the American Society of most common and serious com- Virginia. Okusa and his colleagues may Nephrology. plications of hospitalized pa- have stumbled upon a solution when Atients. Yet there are no FDA-approved Ultrasound alone they unexpectedly discovered that ul- therapies for this disorder except dialysis, trasound exposure provides a simple, Working with Joseph Gigliotti, PhD, and potential drug therapies are associ- portable, noninvasive, and nonpharma- also of the University of Virginia, and ated with a number of adverse effects. cological approach to prevent acute kid- others, Okusa has been developing an ul- “There is an important gap in our ney injury and long-term kidney fibrosis. trasound-based method to deliver drugs ability to address this problem,” said Their findings were published recently specifically to the kidney to prevent or treat ischemia-reperfusion injury. This type of injury contributes to tissue damage and reduced glomerular filtration rate in some patients who undergo major surgery, which can deprive the kidneys of normal blood flow. In addition to de- Continued on page 3 AMERICAN SOCIETY OF NEPHROLOGY Kidney Week: November 5–10 Exhibit Dates: November 7–9 Registration and Housing Now Open www.asn-online.org/KidneyWeek August 2013 | ASN Kidney News | 3 Ultrasound Future analyses will explore the effi- high risk of AKI are planned. tari, MD, MPH, and Diane Rosin, PhD. cacy of ultrasound in reducing mortality “In searching for novel approaches to Therapy in subjects with more severe kidney in- prevent and even cure acute kidney injury, Mark Okusa has the following disclo- Continued from page 1 jury, perhaps from longer ischemic times. we believe that splenic ultrasound stimula- sures: AM Pharma, Nature Publishing Group, Lilly, Daiichi-Sankyo, American veloping after procedures such as kidney Also, research is needed in larger animals tion has a bright future ahead,” they wrote. Physiological Society, International Soci- transplantation and cardiopulmonary and then humans to apply the concepts They also noted that other nonrenal con- ety of Nephrology, PGX Health/Adeno- bypass, renal ischemia-reperfusion injury learned from this study. Finally, the cur- ditions—such as myocardial ischemia, sine Therapeutics, LLC, and UVA Patent contributes to the main pathophysiologi- rent study only addresses preventive ther- hepatic injury, sepsis, and endotoxemia— Office. cal processes that occur during sepsis- apy, and it is unclear whether this form also rely on the cholinergic anti-inflam- of therapy is effective as a treatment after matory pathway and might therefore be Alexander Klibanov has the following dis- contrast- and rhabdomyolysis-induced injury occurs. prevented or treated with the approach. closures: Targeson, Inc, Philips Research. kidney injuries. In an accompanying editorial, Alain ____________________ In the researchers’ approach, they Le Moine, MD, PhD, of the Erasme The article, entitled “Ultrasound Pre- package a drug in a “microbubble” that is Hospital in Belgium, and his colleagues Study co-authors include Liping Huang, vents Renal Ischemia-Reperfusion Injury injected into a laboratory animal. When noted that opportunities arising from the Hong Ye, Amandeep Bajwa, PhD, Kryt by Stimulating the Splenic Cholinergic the drug-loaded microbubble enters into work are numerous and promising be- Chattrabhuti, MD, Sangju Lee, MD, Al- Anti-Inflammatory Pathway,” is available the kidney, ultrasound is used to break up cause many procedures that carry a very exander Klibanov, PhD, Kambiz Kalan- online at http://jasn.asnjournals.org/. the bubbles, thereby releasing the drug and enhancing its delivery to the kidney. Through careful experiments, the research team was surprised to find that ultrasound alone—without drug-laden mi- crobubbles—protected the kidney from ischemic injury. When the investigators exposed anesthetized mice to ultrasound Maintain your with a routine clinical imaging system 24 hours prior to blood disruption to the certification with ASN’s kidneys, the mice exhibited preserved kidney health after blood flow was re- stored. In contrast, sham-treated mice exhibited significant kidney injury. Dialysis Also, ultrasound treatment reduced the infiltration of immune cells that typi- Practice Improvement cally occurs in the kidney after ischemia- reperfusion injury, and it caused a greater than 85% reduction in the renal expres- Module sion of vimentin, α-smooth muscle actin, collagen I, and collagen III mRNA. Ultrasound treatment prevented the marked decline in kidney function as Available Now well as tissue injury, and it also protected the kidneys from subsequent develop- ment of fibrosis. The regimen relied on ASN provides the best learning opportunities in settings within approved Food and Drug kidney care. The Dialysis Practice Improvement Administration guidelines, and the pro- Module (DPIM) guides physicians through a review tective effect of a single exposure lasted for two days. of patient data and supports the implementation of a quality-improvement (QI) plan for their practice. Mechanism of action Additional experiments—including sple- · Evaluate and improve care for dialysis patients nectomies and adoptive transfer studies— revealed that the ultrasound treatment · Implement an individual or practice-wide blocked ischemia-reperfusion-induced improvement plan kidney inflammation through direct action on the spleen, an organ that appears · Earn 20 MOC points from ABIM to modulate the response to acute kidney injury. Blockade or genetic deficiency of the α7 nicotinic acetylcholine receptor abolished the protective effect of ultrasound, suggesting the involvement of the cholinergic anti-inflammatory pathway, which mediates the neural control of sys- Online Learning | The ASN Advantage temic inflammation. www.asn-online.org/pim “Our studies using noninvasive ultrasound now provide us with an active treatment that appears to be simple, effective, and nontoxic for the prevention of acute kidney injury,” said Okusa. “To our knowledge this has never been de- scribed for the prevention of tissue or organ injury. Interestingly, we suspect that similar mechanisms that lead to kidney injury may also lead to lung, heart, and liver damage and that this form of therapy might be effective for prevention of injury in other organs as well.” Learning Center Ad_Mini_DPIM.indd 1 7/10/13 8:55 PM 4 | ASN Kidney News | August 2013 LEADING THE FIGHT ASN AGAINST KIDNEY DISEASE Corporate Editorial Staff Editor-in-Chief: Pascale H. Lane, MD, FASN Supporters Executive Editor: Dawn McCoy Production and Content Editor: Kurtis Pivert Design: Lisa Cain Design ASN gratefully acknowledges the Editorial Board:

Load more