How to treatment for chronic kidney disease?

Controlling blood pressure will slow further kidney damage.
Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are used most often.
The goal is to keep blood pressure at or below 130/80 mmHg

Other tips for protecting the kidneys and preventing heart disease and stroke:
Do not smoke.
Eat meals that are low in fat and cholesterol.
Get regular exercise (talk to your doctor or nurse before starting to exercise).
Take drugs to lower your cholesterol, if needed.
Keep your blood sugar under control.
Avoid eating too much salt or potassium.

Always talk to your kidney doctor before taking any over-the-counter medicine, vitamin, or herbal supplement. Make sure all of the doctors you visit know you have chronic kidney disease.

Other treatments may include:
Special medicines called phosphate binders, to help prevent phosphorous levels from becoming too high
Treatment for anemia, such as extra iron in the diet, iron pills, iron through a vein (intravenous iron) special shots of a medicine called erythropoietin, and blood transfusions
Extra calcium and vitamin D (always talk to your doctor before taking)

You may need to make changes in your diet. See: Diet for chronic kidney disease for more details.
You may need to limit fluids.
Your health care provider may recommend a low-protein diet.
You may have to restrict salt, potassium, phosphorous, and other electrolytes.
It is important to get enough calories when you are losing weight.

Different treatments are available for problems with sleep or restless legs syndrome.

Everyone with chronic kidney disease should be up-to-date on important vaccinations, including:
H1N1 (swine flu) vaccine
Hepatitis A vaccine
Hepatitis B vaccine
Influenza vaccine
Pneumococcal polysaccharide vaccine (PPV)

When the loss of kidney function becomes more severe, you will need to prepare for dialysis or a kidney transplant.
When you start dialysis depends on different factors, including your lab test results, severity of symptoms, and readiness.
You should begin to prepare for dialysis before you need it. Learn about dialysis and the types of dialysis therapies, and how a dialysis access is placed.
Even people who are candidates for a kidney transplant may need dialysis while waiting for a kidney to become available.

what is Symptoms of Lupus Nephritis?

Lupus nephritis is kidney inflammation caused by systemic lupus erythematosus (SLE or lupus). SLE is an autoimmune disease—a disorder in which the body’s immune system attacks the body’s own cells and organs. Up to 60 percent of people with SLE are diagnosed with lupus nephritis, which can lead to significant illness and even death.

Symptoms of lupus nephritis include:
Blood in the urine
Foamy appearance to urine
High blood pressure
Swelling of any area of the body

joint pain or swelling
muscle pain
fever with no known cause
red rashes, often on the face, which are also called butterfly rashes because of their shape

What causes chronic kidney disease?

The two main causes of chronic kidney disease are diabetes and high blood pressure, which are responsible for up to two-thirds of the cases. Diabetes happens when your blood sugar is too high, causing damage to many organs in your body, including the kidneys and heart, as well as blood vessels, nerves and eyes. High blood pressure, or hypertension, occurs when the pressure of your blood against the walls of your blood vessels increases. If uncontrolled, or poorly controlled, high blood pressure can be a leading cause of heart attacks, strokes and chronic kidney disease. Also, chronic kidney disease can cause high blood pressure.

Other conditions that affect the kidneys are:
·Glomerulonephritis, a group of diseases that cause inflammation and damage to the kidney's filtering units. These disorders are the third most common type of kidney disease.
·Inherited diseases, such as polycystic kidney disease, which causes large cysts to form in the kidneys and damage the surrounding tissue.
·Malformations that occur as a baby develops in its mother's womb. For example, a narrowing may occur that prevents normal outflow of urine and causes urine to flow back up to the kidney. This causes infections and may damage the kidneys.
Lupus and other diseases that affect the body's immune system.
·Obstructions caused by problems like kidney stones, tumors or an enlarged prostate gland in men.
Repeated urinary infections.

A number of conditions can cause permanent damage to the kidneys and/or affect the function of the kidneys and lead to CKD. Three common causes in the UK, which probably account for about 3 in 4 cases of CKD in adults, are:
·Diabetes. Diabetic kidney disease is a common complication of diabetes.
·High blood pressure. Untreated or poorly treated high blood pressure is a major cause of CKD. However, CKD can also cause high blood pressure, as the kidney has a role in blood pressure regulation. About nine out of ten people with CKD stages 3-5 have high blood pressure.
·Ageing kidneys. There appears to be an age-related decline in kidney function. About half of people aged 75 or more have some degree of CKD. In most of these cases the CKD does not progress beyond the moderate stage unless other problems of the kidney develop, such as diabetic kidney disease.

There are various other less common conditions that can cause CKD.

Acute Kidney Injury In Emergency Cases - Using Biomarkers

A study published online in the Journal of the American College of Cardiology reports that researchers have discovered a new approach for diagnosing acute kidney injury (AKI), which has severe consequences with a 25 to 80% risk of in-hospital death, that allows emergency departments to identify high-risk patients on admission.

To determine kidney function, physicians commonly measure patients' creatinine levels, however, these levels can remain normal for several hours following acute kidney damage. In order to achieve a precise assessment, physicians need to take measurements over a one to three day period, which limits the use in an emergency room.

Thomas Nickolas, MD, MS, assistant professor of clinical medicine at Columbia University College of Physicians and Surgeons and a kidney specialist at New York-Presbyterian Hospital/The Allen Hospital explains that in contrast, urinary biomarkers only take approximately half an hour for obtaining a measure of the severity of kidney damage.

In an international multi-center collaboration at the New York-Presbyterian Hospital/Columbia University Medical Center, the Staten Island University Hospital, the Charité-Universitätsmedizin, the Max Delbruck Center for Molecular Medicine, and Helios Clinics in Berlin, Germany, researchers evaluated the new approach for the diagnosis of acute kidney injury.

They obtained a single measure of five urinary biomarkers from 1,635 emergency room patients upon hospital admission. The researchers noted that even though all five biomarkers were elevated in incidents of intrinsic AKI (iAKI), the most severe form of AKI, the biomarker called uNGAL was most precise in diagnosing iAKI.

It was also the biomarker, which best predicted the duration and severity of the injury. Both uNGAL and another biomarker, named Kim-1 were reported to be the most accurate biomarkers in predicting death or the need to initiate dialysis during hospitalization. The biomarker uNGAL was identified at the New York-Presbyterian Hospital/Columbia University Medical Center and at Cincinnati Children's Hospital. In this study, researchers measured uNGAL by Abbott's ARCHITECT-NGAL assay, which can be obtained commercially outside the US.

Senior researcher Jonathan Barasch, MD, PhD, associate professor of medicine and of anatomy and cell biology at the Columbia University College of Physicians and Surgeons, who is also a kidney specialist at the New York-Presbyterian Hospital/The Allen Hospital declared:

"The ability to identify acute kidney damage while the patient is in triage is especially important in busy urban hospitals, where patients cannot wait for repetitive measures of creatinine and are frequently lost to follow-up. The use of urinary biomarkers could also be of great use to the military, at disaster sites, and in other situations where quick medical decisions must be made."

Dr. Kai Schmidt-Ott, MD, a kidney specialist at the Charité Berlin and research group leader at the Max Delbrück Center for Molecular Medicine, who is also adjunct assistant professor at Columbia University Medical Center added:

"Combining urinary biomarkers such as uNGAL with the current standard marker creatinine will significantly improve the identification of patients at risk of death or dialysis in the hospital. Identifying these patients at the earliest possible time in the emergency room may enable us to introduce new treatment options to improve their outcomes."

Nurse Donates Own Kidney To Patient

Nurse Allison Batson donated one of her own kidneys to 23-year old patient, Clay Taber; somebody she barely knew, after working on the transplant department of Emory University Hospital for over two years. Allison was not even Clay's primary nurse, but says she felt an instant connection with him.

Taber, from Columbus, Ga., became ill when he was 22, and eventually suffered from complete kidney failure. He started feeling sick and suffered occasional night sweats. At first tests came back positive for some signs of monocucleosis (infection with the Epstein-Barr virus), however, subsequent tests showed that his kidneys were in failure. Taber's mother says she was shopping for some groceries when the hospital telephoned, explaining that new tests had showed that her son was in complete kidney failure and that he had to be admitted to hospital straight away.

Taber was diagnosed with Goodpasture's syndrome - a very rare disorder in which the patient's immune system attacks the kidneys and lungs, as if they were harmful pathogens. Goodpasture's syndrome often occurs after a viral infection, inhaling gasoline, or inhaling some other type of hydrocarbon solvent. Taber and his family wondered whether his recent vacation in the Gulf of Mexico, where he swam in water that had been affected by the oil spill, may have been a contributory factor.

Fortunately for Taber, his diagnosis was made before his lungs had been attacked by his immune system. However, he urgently needed a kidney transplant. He became a patient in the transplant unit of Emory University Hospital, Atlanta, where nurse Batson worked.

The patient's mother and other family members did not qualify as kidney donors. Initially, his mother appeared to be a good donor match. However, the doctors found that the lining of her kidneys was not thick enough to remove one. Batson, who has four children herself, said she really related to Taber's mother's plight. Then, it occurred to her that perhaps she could come forward as a donor herself. She discussed her thoughts with her family, who all supported her decision to become a kidney donor.

Batson, who says her children are around the same age as Clay, was really touched; she added "We really connected."

Batson said:


"Immediately, when Clay came onto our unit, he became a special patient that everyone just gravitated to. Here was this young man with everything in his life ahead of him, and he was fighting for his life. He quickly became friends of many of the staff, and really was just a tremendous inspiration to us all."


Taber joined 90,000 other Americans who had been waiting for a donor kidney. Doctors informed him that it would probably take from between three to five years before a suitable organ could be found for him. Taber, who explained that he and Batson had only known each other for six weeks, described what happened as "A blessing from God. I've got a piece of her in me and I will forever. She will have a special dance at my wedding" (Taber gets married this year in June).

In a press release, Batson said:


"People have asked me why I would do this for a stranger, or what if I had a family member in need one day, or why would I risk my own life or health for someone I barely know. My answer is because I can. Sure, I have children who might possibly be in need one day, but here was this young man right in front of me who needs help - today, and I am in a position to help him - today. If what I do for Clay causes more awareness among others that live organ donation is a possibility, then I can only hope that other lives will be saved because of my actions."

Cochlear Implants Can Be Safe And Effective For Kidney Transplant Patients Who Lose Their Hearing

Some people who undergo organ transplants lose their hearing as a side-effect of the antibiotics and immunosuppressive drugs they have to take. And while cochlear implants that restore hearing can raise the risk of getting ear infections and are thus not normally considered for patients with weakened immune systems, Kenneth Charles Iverson and Brian John McKinnon, of the Medical College of Georgia (MCG) at Georgia Health Sciences University in Augusta, suggest that under certain conditions they may be safe and effective for kidney transplant patients.

They write about their study in the January issue of theAmerican Journal of Otolaryngology.

The inner ear contains a finite number of dark cells. These produce the tiny amounts of fluid that help transform sound vibrations into neural signals that can be processed by the brain.

These dark cells have a very active metabolism: something that antibiotics are designed to target in bacteria.

When a recipient patient receives a donated organ, they have to keep taking antibiotics and other drugs to stop their immune system rejecting it.

So long term use of these drugs can result in deafness, because destruction of the dark cells also destroys the ability to make the fluid, and any sound entering the ear is then likely to be incomprehensible.

But not many trasplant patients have cochlear implants because they can increase the risk of infection in the inner ear, and an immune system already weakened by drugs is only likely to increase that risk. (The electrode that connects the cochlear device to the inner ear is a highway not just for sound vibrations but also for viruses and bacteria.)

In fact, people who are not transplant patients who receive cochlear implants usually also have vaccinations to boost their immune response to common infections.

But you can't do this with transplant patients:

"If you do make the immune system work better, they may reject their organ," McKinnon, an otologist and neurotologist at the MCG, told the press.

So McKinnon and Iverson, who is Chief Resident in otolaryngology at MCG, conducted a small retrospective study to find out if there was any way that transplant patients could benefit from cochlear implants without raising these risks.

And what they found was that if the patient waits at least six months after the transplant, and takes the correct antibiotics before and after receiving the cochlear implant, then they may be able to restore their hearing without raising the health risk.

The study focuses on two patients who had cochlear implants after receiving new kidneys.

One patient was a 47-year-old woman who became very deaf after being treated in intensive care with several powerful antibiotics for an infection that set in after receiving a kidney from a living family member.

She received her cochlear implant 18 months after the infection and 6 years after her kidney transplant. Before the cochlear implant surgery she received an intravenous antibiotic, and afterwards she took an oral antibiotic for a week. She stayed on her usual transplant medication throughout.

13 months after the cochlear implant surgery, her hearing was essentially back to normal. Unfortunately, she died two years after her implant, from health problems not related to it.

The other patient was a 50-year-old man who received his kidney from a deceased donor. He lost his hearing six weeks after a severe brain infection. He had surgery to fit a cochlear implant 7 months after the kidney transplant, and underwent similar antibiotic treatment as the female patient. 14 months later, around 75% of his hearing was restored.

Iverson and McKinnon write that the "study adds to the growing evidence that successful cochlear implantation can be achieved in appropriately selected renal transplant patients".

Click here to learn more about cochlear implants from the National Institute on Deafness and Other Communication Disorders (part of the National Institutes of Health in the US).

The Power Of Kidney Transplant Chains When People "Pay It Forward"

The worlds longest living donor kidney transplant chain, which has just ended at Loyola Medical Center in Maywood, Illinois, USA, was made possible by people who were driven to "pay it forward".

This chain started when Rick Ruzzamenti, a self-admitted "impulsive" man decided to donate his kidney, after being motivated by a friend who had done the same for a women she knew. After hearing her story, Ruzzamenti was motivated to donate a kidney, and even though he did not know who would end up with his kidney, he donated it anyway.

His donation ended up going to a man whose niece was willing to give him the kidney, however, she was not a compatible match. When her uncle received the kidney from Ruzzamenti, she donated her kidney to someone else who needed one.

Don Terry, who was the last person to receive a kidney in the chain, was told it may take up to 5 years to find a donor, was diagnosed with diabetes-related renal disease during his 40's. He was living with bloating, burning, and the horrible effects from dialysis for almost a year. Because of Ruzzamenti's original donation, Terry was able to receive a kidney much faster than he otherwise would have.

Terry said:

"It was like being sentenced to prison.. like I had done something wrong in my life and this was the outcome. This kidney chain has brought me back to life."

After Ruzzamenti kicked off this chain, 60 operations were allowable because of other willing donors who were planning on giving kidneys to loved ones, but were not compatible. These generous people donated to someone they didn't know, and in exchange, their loved ones were given a kidney from someone else.

The chain, called Chain 124, by the nonprofit National Kidney Registry, was possible because of massive coordination, and many good Samaritans. It required cutting-edge computer matching, amazing surgical techniques, and outstanding organ shipping.

A transplant surgeon at Johns Hopkins Hospital, a hospital which was not involved in the chain, commented that the chain was a "momentous feat". He said:

"We are realizing the dream of extending the miracle of transplantation to thousands of additional patients each year."

Loyola was responsible for 13 chains - 5 of which were started by Loyola employees, who donated their kidneys to people in need.

John Milner, a Loyola transplant surgeon, explained that patients who do not have a family member with a matching kidney can wait up to 10 years for a transplant, but with these donations, patients can receive a live transplant within 6 months.

Milner commented:

"There are people right now today in this city who have willing healthy living donors who don't match their recipients but don't know about this program."

Terry, the final recipient of this long lasting chain, commented:

"I'm here because I want to see more people (getting transplants). There are 100,000 people dying before you. Please make sure there isn't one more who has to."

The chains have consisted of parents donating to children, children donating to parents, sisters and brothers donating to each other and even people donating to their ex's for the sake of their children.

Prior to this chain, the longest was 23 transplants in 2010, by the National Kidney Registry. Dr. Milner concluded

"This is the best way for patients with incompatible donors to be transplanted quickly with the best results.

This chain ends, but another one begins."

Kidney Donors Heart Disease Risk Not Increased

According to a study published on bmj.com, there is no difference in the risk of developing heart disease between living kidney donors and the healthy general population.

Results from the study provide recipients, donors, and transplant experts, vital safety reassurances.

There is a strong association between an increased risk of heart disease and reduced kidney function in the general population. Because kidney donors lose half of their kidney mass, is important for doctors to determine whether this risk extends to them.

Although prior investigations have indicated no increase in risk, a consensus has not yet been achieved. Hence, American, Australian, and Canadian researchers conducted a study in order to find out whther kidney donors have an increased risk of developing heart disease.

The study compared 2,028 individuals in Ontario, Canada, who donated a kidney between 1992 and 2009, with 20,280 healthy non-donors.

The team examined each donors' medical records and linked them to national healthcare databases in order to monitor major cardiovascular events over an average of 6.5 years.

In addition, they conducted additional evaluations according to year of donation to identify any tends in risk over a longer period of time. 


Even though kidney donors had reduced kidney function, results from the study showed that donors had a lower risk of death or first major cardiovascular event (2.8 per 1,000 person years), than non-donors (4.1 per 1,000 person years).

In addition, the team found no considerable difference between donors and non-donors in the risk of major cardiovascular events (1.7 compared with 2 events per 1,000 person years).

Furthermore, they found no increased risk among younger donors or older donors. According to the researchers, this is probably because only healthy individuals are considered for living kidney donation, in our area, and they also undergo frequent medical follow up after donating.

The researchers highlight that the risk of major cardiovascular events in kidney donors is no higher in the first 10 years following the procedure than in matched non-donors. They add that it is possible that a link between heart disease risk and living kidney donation exists, although it takes significantly longer to manifest. As a result, they advise that donors should be monitored frequently.

According to the researchers, their study "adds to the available evidence base supporting the safety of the practice amongst carefully selected donors."

In an associated report, investigators at the University of Michigan state that the study resolves the uncertainty that continues regarding the full magnitude of risks believed by living kidney donors and "makes an important contribution to our understanding of the long term consequences of living kidney donation."

Revolutionary New Kidney Transplant Procedure

Kidney Research UK has announced that their scientists have discovered a revolutionary new method to increase success rate and longevity of kidney transplants. They have also discovered a method to enable more marginal donors organs to be used for transplantation, where they would have previously been unusable.

The process is actually relatively simple. The doctors flush the kidney with oxygenated blood prior to the transplant surgery. This process, known as normothermic perfusion, is seen to reverse the damage done to the organ by storing them at low temperatures while awaiting the surgical operation. The oxygenated organ performs better immediately after the grafting procedure. Kidneys that restore full function early after the implant, have been shown to last longer and perform better.

It is thought that the new process can not only increase lifespan of the patient, but also reduce rejection rates. The current lifespan of someone with a grafted kidney is only 10-15 years, and while on one hand, the process seems like common sense, it's a wonder no one thought of it 20 years ago. On the other hand, it is great news for anyone awaiting a kidney transplant.

Professor Mike Nicholson, lead researcher for Kidney Research UK, said:


"Normothermic perfusion allows us to gradually reintroduce blood flow to donor kidneys outside of the body and in a controlled way ... This reverses much of the damage caused by cold storage, while offering us a unique opportunity to treat the organs with anti-inflammatory agents and other drugs before going on to complete the transplant procedure ...In short, we're able repair and revive damaged kidneys in a way that would otherwise be impossible."


So far, only one of 17 kidneys transplanted using the normothermic perfusion showed signs of delayed function. This delay in the organ coming back to life is seen as a primary cause of rejection and it is not uncommon for delayed function to occur in upto fifty percent of kidney transplant patients.

Professor Nicholson continues that :


There's often great reluctance among health professionals to use kidneys from marginal donors, as there's no way to establish how much damage has been caused to the organs and whether or not they will work ... As a result, these organs are often discarded as a precaution, rather than taking the risk of using them for transplants ... Normothermic perfusion allows us to perform a crucial viability check on these kidneys, pumping them with blood to confirm whether or not they function adequately enough to be used for transplantation."
In the UK, a mere 3000 transplants are performed each year, while some ninety percent of all patients waiting for donor organs are those needing replacement kidneys. More than half of those who die from uncontrolled cardiac arrest are unsuitable for transplantation and must be discarded, so it is thought that the normothermic perfusion process can cut the waiting list by more than 10%. This could have a profound effect on the NHS, which currently spends more than three billion per year treating patients waiting for replacement kidneys.

For example, the average cost of treating a patient waiting for a new kidney is some £30,000 ($45,000) per year, the transplant operation whether successful or not costs some £42,000 ($63,000), while the cost of treating a patient with a donated organ implanted is reduced to around £6,500 per year, meaning that a patient who is off dialysis and using a donated organ is saving the health service some £24,000 ($36,000) per year.

Charles Kernahan, Chief Executive of Kidney Research UK, said:


"This project represents a major step in the fight against kidney disease. Although transplantation is by no means a cure for kidney failure, it is by far the best treatment method available to us at this time ... In developing a process that not only maximises the quality of kidneys taken from marginal donors but could also lead to hundreds more transplants being carried out each year, our researchers have given fresh hope to the 7,000 people in the UK currently waiting for a kidney."
Kidney Research UK is now appealing for more funding in order to take normothermic perfusion on to clinical trials. They are accepting donations on their website

Childhood Acute Kidney Injury In ICU Raises Risk Of Chronic Kidney Disease

According to a study published in the April issue of theAmerican Journal of Kidney Diseases, children are more likely to develop chronic kidney disease (CKD) if they have suffered and recovered from acute kidney injury (AKI) in an intensive care unit (ICU).

The researchers examined 126 children with AKI below the age of 18 years. AKI is a rapid loss of kidney function that can develop in the ICU as a result of treatment complications or severe illness. To determine the number of children who developed CKD, the authors assessed the patients at 1 to 3 years after they suffered AKI.

Lead author of the study, Dr. Cherry Mammen, of British Columbia Children's Hospital in Vancouver, Canada, explained:

"The long-term implications of a single episode of acute kidney injury on overall kidney health has been well studied in critically-ill adult patients, but not in children."
In children admitted to the ICU, AKI is primarily caused through lack of oxygen and blood flow to the kidneys. AKI may occur from various medications, severe infections (sepsis) and from major operations, including cardiac surgery.

The researchers found that around 10% of children who had AKI in the ICU developed chronic kidney disease, as defined by reduced kidney function from blood tests and/or protein in the urine. Furthermore, results indicated that 47% of children in the study were at risk of developing CKD with findings such as high blood pressure and mildly reduced kidney function.

Dr. Mammen, said:


"As pediatric ICU populations are growing and more are surviving due to advances in ICU care, it is important to identify AKI as a possible risk factor for future development of CDK.

Acute Kidney injury is a common event in the ICU setting. Currently, many of these kids who suffer from AKI are not followed by a nephrologist, or kidney specialist, and in general are not monitored for their kidney health long term."
According to Dr. Mammen, the study has paved the way for additional studies on AKI, including determining the best methods for measuring kidney injury in neonates, infants undergoing cardiac surgery, as well as other high risk populations.

Dr. Kerry Willis, National Kidney Foundation Senior Vice President of Scientific and Medical Activities, explained:


"The study's findings indicate the importance of children receiving follow-up care with a nephrologist, or a physician who will be able to monitor kidney function after AKI.

It could be as simple as an annual urinalysis and blood pressure check...Of you catch CDK early in a child, you may be able to treat it or slow its progression."

Genetic Mutations Linked To Childhood Kidney Cancer

According to a study published in Nature Genetics, an international team of researchers have identified mutations in two regions of the genome that increase the risk of developing Wilms tumor.

Wilms tumor is the most prevalent type of kidney cancer in children and usually develops before the age of five. The disease affects around 1 in 10,000 children and has a 90% cure rate. In the majority of children researchers are unsure as to what causes the tumor although they know that genes play a role.

In this study, the researchers report on the first scan of common mutations in the genomes of Wilms tumor patients.

The researchers used a genome wide association study in order to compare common DNA mutations in the genetic code of nearly 1,500 Wilms tumor patients with variants in 3,850 healthy individuals in the UK and the United States.

The team identified two chromosomes (2 and 11) that contained mutations that were considerably more prevalent among individuals affected by the disease.

Lead author of the study, Professor Nazneen from The Institute of Cancer Research (ICR) and The Royal Marsden NHS Foundation Trust, explained:




"Our previous studies show that there are undiscovered genetic factors that cause Wilms tumor, and this study brings us an important step closer to finding them.

The next step is to determine exactly what it is about these regions of the genome that is causing the link with Wilms tumor. This will lead to better understanding of the condition and, potentially, improved treatments."




According to the researchers, the DNA regions where these variations have been found include genes known to be associated in other diseases and cancer. The identification of these variations well help researchers to better understand the biological pathways that may cause Wilms tumor, and are also a potential target for new medications.

On chromosome 11, the researchers found a variant in the gene DLG2. DLG2 is part of a biological system that makes sure tissue grows correctly during development, and according to previous studies, disruption of this pathway is linked to cancer. In addition on chromosome 2, the team found a variant near the gene DDX1, which is involved in repairing damaged DNA. Several known cancer genes also have similar roles in DNA repair.

Furthermore, the researchers found three other DNA mutations also likely to be associated to Wilms tumor which they are currently studying further.

Predicting Risk Of Death In End-Stage Kidney Disease, New Equation More Accurate

A study in the May 9 edition of JAMAreveals that fewer people were classified as having chronic kidney disease, and more accurate predictions of the mortality risk and end-stage renal disease were made under a newer equation of risk prediction.

Glomerular filtration rate (GRF) is a test used to determine whether the kidneys are functioning properly and is used in the diagnosis of chronic kidney disease (CKD). In addition, GRF is an independent predictor of all-cause and cardiovascular mortality and renal failure. According to clinical guidelines, physicians are advised to report estimated GFR when measuring serum creatinine levels.

The researchers said:




"The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation more accurately estimates GFR than the Modification of Diet in Renal Disease (MDRD) Study equation using the same variables [age, sex, race, and serum creatinine level], especially at higher GFR, but definitive evidence of its risk implications in diverse settings is lacking."




In order to assess if estimated GFR calculated by the CKD-EPI equation predicts risk for adverse outcomes more accurately than the MDRD Study equation in a broad range of populations, Kunihiro Matsushita, M.D., Ph.D., of the Johns Hopkins University, Baltimore, and colleagues conducted a meta-analysis using data from 13 CKD cohorts, 25 general population cohorts, and 7 high-risk cohorts (of vascular disease).

The researchers examined data from 1.1 million individuals aged 18+ from 40 countries or regions of Asia, North America and South America, Europe, Oceania, and the Middle East. Data transfer and analyses were carried out between March 2011 and March 2012.

The primary adverse outcomes the researchers examined were:
end-stage renal disease (ESRD) (7,644 events from 21 cohorts)
all-cause mortality (84,482 deaths from 40 cohorts
cardiovascular mortality (22,176 events from 28 cohorts)

The researchers classified estimated GFR into six categories by both equations (90 or greater, 60-89, 45-59, 30-44, 15-29, and <15 mL/min/1.73 m2). The CKD-EPI equation reclassified around one-fourth of study participants to a higher estimated GFR category (24.4% in the general population cohorts, 15.4% in the high-risk cohorts, and 6.6% in the CKD cohorts) vs. the MDRD Study equation. According to the researchers, this reduced the prevalence of CKD in all cohorts apart from the elderly.

Furthermore, the the researchers found that around 0.6% of patients were reclassified to a lower category. Participants who were reclassified to a lower category (0.7%) had a higher risk of mortality and ESRD than patients who were not reclassified even after adjusting for different factors, while those who were reclassified to a higher category had lower risks.

According to the researchers, the prevalence of CKD stages 3 to 5 (<60 mL/min/1.73 m2) was lower by the CKD-EPI equation (6.3%) than by the MDRD Study equation (8.7%), as well as in the high-risk cohorts (14.6% vs.17.7%, respectively).

The researchers explained:

"Net reclassification improvement based on estimated GFR categories was significantly positive for all outcomes. Net reclassification improvement was similarly positive in most subgroups defined by age (<65 years and 65 years and older), sex, race/ethnicity (white, Asian, and black), and presence or absence of diabetes and hypertension. The results in the high-risk and CKD cohorts were largely consistent with the general population cohorts."

They conclude:




"Overall, the CKD-EPI creatinine-based equation more accurately classified individuals with respect to risk of mortality and ESRD compared with the MDRD Study equation.

Given more accurate GFR estimation, lower CKD prevalence estimates, and better risk categorization by the CKD-EPI equation without additional laboratory costs, its implementation for estimated GFR reporting could contribute to more efficient and targeted prevention and management of CKD-related outcomes."




In an associated report, Kamyar Kalantar-Zadeh, M.D., M.P.H., Ph.D., of the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, Calif., and Alpesh N. Amin, M.D., M.B.A., of the University of California-Irvine Medical Center, explained that:




"Even though CKD staging using the more conservative CKD-EPI equation seems valid because it produces more meaningful risk profiles, it is premature to conclude that the ultimate tool for estimated GFR accuracy has been found."




They continue:





"An even more conservative and accurate equation may be developed eventually, perhaps by these same investigators who first developed and advocated the MDRD equation (that is still in use in many estimated GFR laboratory reports) and who have now advanced the CKD-EPI equation to replace its MDRD predecessor.

Some inherent limitations of the MDRD equation remain essentially unchanged in the CKD-EPI equation, in particular the reliance on creatinine as a single suboptimal filtration marker that not only is a close correlate of skeletal muscle mass but also probably varies with the magnitude of ingested meat and nutritional status.

To date no single circulating biomarker meets the desired criteria of the ideal renal filtration marker. It is possible that a panel of several filtration markers, including cystatin C, for instance, combined with some surrogate markers of nutritional status and body composition, will provide a more accurate and clinically meaningful estimate of GFR."

Folic Acid May Reduce Pediatric Kidney And Brain Tumors

A new study in the current issue ofPediatrics reveals that folic acid fortification of foods could potentially reduce the number of incidences of Wilm's tumor, the most common type of kidney cancer, and primitive neuroectodermal tumors (PNET), a type of brain cancer in children. The U.S. Food and Drug Administration has mandated since 1998 that foods are to be fortified with folic acid based on evidence of previous studies that prenatal consumption of folic acid considerably decreases the number of incidences in neural tube defects in babies.

Kimberly J. Johnson, PhD, assistant professor at the Brown School at Washington University in St. Louis says: "Our study is the largest to date to show that folic acid fortification may also lower the incidence of certain types of childhood cancer in the United States."

In their study, Johnson and her team assessed the incidence rate of childhood cancer pre- and post-mandated folic acid fortification.

Johnson declares:

"We found that Wilms' tumor rates increased from 1986 to 1997 and decreased thereafter, which is an interesting finding since the downward change in the trend coincides exactly with folic acid fortification.

PNET rates increased from 1986 to 1993 and decreased thereafter. This change in the trend does not coincide exactly with folic acid fortification, but does coincide nicely with the 1992 recommendation for women of childbearing age to consume 400 micrograms of folic acid daily."

The team obtained data from between 1986 to 2008 from the National Cancer Institute's Surveillance, Epidemiology and the End Results Program (SEER), which lists data on cancer cases from all over the U.S. since 1973, involving 8,829 children with cancer from birth to the age of four.

Johnson declares: "Declines in Wilms' tumors and PNETs in children were detected by multiple analyses of the data. Importantly, the reduced rates of Wilms' tumors also were found in a smaller study conducted in Ontario, Canada, that was published in 2011. More research is needed to confirm these results and to rule out any other explanations."

According to Johnson countries need to consider the possibility that fortification could potentially cause other harms, like new cancers or pre-cancerous lesions when deciding whether or not to fortify foods to decrease neural tube defects in newborns. However, in terms of this study Johnson concludes: "Here, we are showing that folic acid fortification does not appear to be increasing rates of childhood cancers, which is good news."

Glucose Control May Not Reduce Kidney Failure In Type 2 Diabetes Patients

Aggressive glucose (glycemic) control may not reduce the risk of kidney failure in individuals with type-2 diabetes, according to Yale researchers.

The study is published in Archives of Internal Medicine.

In order to determine whether aggressive glucose control can prevent renal disease in individuals with type 2 diabetes mellitus, Steven G. Coca, assistant professor in the section of nephrology in the Department of Internal Medicine at Yale, and his team examined data from 7 trials involving 28,065 adult patients.

According to the researchers findings, the risk of impaired kidney function, the need for dialysis or death from renal disease was not reduced among participants who received aggressive glucose control with higher doses of medication vs. patients who underwent usual treatment.

Coca notes that many researchers were under the assumption that intensive glucose control would protect the patients kidneys. However, results from this study raises the question of whether this approach actually benefits patients.

Coca explained:




"After pooling the results from the follow-up data in the seven studies examined, our analysis shows that intensive glycemic control may improve some things about the kidney that we measure, but did not affect patients' outcomes."

Aspirin Lowers Post-Operative Heart Surgery Kidney Failure Risk

Heart surgery patients can considerably reduce their risk of developing post-operative acute renal failure by taking aspirin for five days before undergoing surgery.

The study, conducted by Professor Jianzhong Sun (M.D., Ph.D.), professor and attending anesthesiologist at Jefferson Medical College, Thomas Jefferson University, Philadelphia, US, was presented Sunday June 10th at the European Anesthesiology Congress in Paris.

The researchers enrolled 3,219 patients who were due to undergo coronary artery bypass graft (CABG), valve surgery or both, to participate in the study. Acute kidney failure or injury is a common post-operative complication and has a significant impact on the survival of patients undergoing heart surgery.

2,247 participants were given aspirin for five days before their operation and 972 receive no aspirin. Although the team had no record of the precise dose taken, the normal dose for aspirin that is taken over a period of time is between 80-325mg.

The researchers took into account various factors, such as disease, age, and other medications, and found that acute kidney failure occurred in just 3.8% of patients taking aspirin (86 out of 2,247) versus 6.7% of patients not taking aspirin (65 out of 972). These findings show that aspirin can reduce the risk of acute renal failure by around 50%.

Professor Sun explained:

"Thus, the results of this clinical study showed that pre-operative therapy with aspirin is associated with preventing about an extra three cases of acute renal failure per 100 patients undergoing CABG or/and valve surgery."

According to Professor Sun, acute renal failure or injury "significantly increases hospital stay, the incidence of other complications and mortality. From previous reports, up to 30% of patients who undergo cardiac surgery develop acute renal failure. In our studies, about 16-40% of cardiac surgery patients developed it in various degrees, depending upon how their kidneys were functioning before the operation. Despite intensive studies we don't understand yet why kidney failure can develop after cardiac surgery, but possible mechanisms could involve inflammatory and neurohormonal factors, reduced blood supply, reperfusion injury, kidney toxicity and/or their combinations."

Professor Sun continued:





"For many years, aspirin as an anti-platelet and anti-inflammatory agent has been one of the major medicines in prevention and treatment of cardiovascular disease in non-surgical settings. Now its applications have spread to surgical fields, including cardiac surgery, and further, to non-cardiovascular diseases, such as the prevention of cancer.

Looking back and ahead, I believe we can say that aspirin is really a wonder drug, and its wide applications and multiple benefits are truly beyond what we could expect and certainly worthy of further studies both in bench and bedside research."




More trials are needed in order to investigate how aspirin helps prevent post-operative kidney failure, says Sun. He believes that the effect might also be seen in individuals undergoing non-cardiac surgeries.

"For instance, the PeriOperative ISchemic Evaluation-2 trial (POISE-2) is ongoing and aims to test whether small doses of aspirin, given individually for a short period before and after major non-cardiac surgeries, could prevent major cardiovascular complications such as heart attacksand death, around the time of surgery."

The team also found that high blood pressure, diabetes, heart failure, heart disease, and diseases of the vascular system were all separate risk factors for post-operative acute renal failure.

Chronic Kidney Disease Independent Sign For Risk Of Death And ERSD

Even in patients without diabetes or high blood pressure, the existence of chronic disease alone may be a powerful sign of the risk of death and end-stage renal disease (ESRD).

The findings, published in The Lancet, came from two recent studies from the Johns Hopkins Bloomberg School of Public Health and the Chronic Kidney Disease Prognosis Consortium.

According to previous research in theJournal of the American Medical Association (JAMA), the prevalence of chronic kidney disease has risen, party because there has been an increase in the number of people with diabetes and hypertension.

Chronic kidney disease is the slow loss of kidney function over time, the main function of the kidneys being to remove wastes and excess water from our bodies. It strikes 10 to 16% of all adults in the United States, Asia, Europe, and Australia. Frequent conditions with the disease are hypertension and diabetes, with hypertension being the most widespread.

A report from 2011 revealed that the health of chronic kidney disease patients can be improved by regular physical activity. For instance, they may benefit from improved physical fitness, healthier blood pressure, healthier heart rates, and higher health-related quality of life.

By estimating glomerular filtration rate (GFR) - the flow rate of filtered fluid that passes through the tiny filters in the kidneys, called glomeruli, each minute - kidney function can be measured. Results reading 60 or more indicate normal functioning, while a low number may imply kidney disease. Albumin, the major protein in the urine standardized for urine concentration, can be measured to quantify kidney damage.

An association was found between low kidney function and high urine protein with all-cause and cardiovascular mortality and ESRD (the fifth stage of chronic kidney disease meaning chronic kidney failure) in both participants with hypertension and in those without, in the hypertension meta-analysis.

Results showed that the associations of kidney function and urine protein with mortality outcomes were more significant in people without hypertension than in those with the condition. On the contrary, the associations between kidney function and urine protein with ESRD showed no differences whether hypertension existed or not.

The report from the diabetes analysis implied that subjects with diabetes had an increased risk of all-cause, cardiovascular mortality and ESRD, compared to those without diabetes across all ranges of kidney function and urine protein.

On the other hand, the comparative chances of these results by kidney function and urine protein are very similar regardless of the existence of diabetes.

Bakhtawar K. Mahmoodi, MD, PhD, lead author of the hypertension analyses, explained, "Chronic kidney disease should be regarded as at least an equally relevant risk factor for mortality and ESRD in individuals without hypertension as it is in those with hypertension."

Josef Coresh, MD, PhD, MHS, the Consortium's principal investigator and professor in the Bloomberg School's Department of Epidemiology, concluded:




"These data provide support for clinical practice guidelines which stage chronic kidney disease based on kidney function and urine protein across all causes of kidney disease. The conclusions are strengthened by the findings of leading studies and the participation of investigators from 40, countries and a detailed analysis of over 1 million participants."

Infections Related To Kidney Stones Twice As Common In Females

Although kidney stones and other obstructions in the urinary tract are more common in men, women are twice as likely to develop infections related to the condition.

Research from 2011 showed a dramatic rise in the number of women developing kidney stones, due to an increase in bad habits, including smoking and drinking. Another report suggested that drinking iced tea can lead to painful kidney stones because of its high concentration of oxalate, one of the key chemicals that lead to the formation ofkidney stones.

The current study, led by a team of experts at Henry Ford Hospital, also found considerably higher percentages of complications following one of two critical treatments for the effects of urolithiasis (stones in the kidneys and urinary tract).

Published in the journal European Urology, results showed that females are much more vulnerable to infection when they fall ill with urolithiasis. It also showed the prevalence of infection, including sepsis (a potentially fatal swelling throughout the body which started off as an infection), is on the rise.

On the other hand, the percentage of associated deaths remains fixed. The scientists believe this is because of "broad improvement in the management of sepsis and the critically ill."

Jesse Sammon, DO, leading author and Urology Resident at Henry Ford's Vattikuti Urology Institute, explained:





"The research study was conducted because the rate of infection related to urolithiasis was not known, and evidence was unclear about the best method for treating it."




Data of almost 400,000 adult patients hospitalized with infected urolithiasis from 1999-2009 was gathered, and later analyzed, from the Nationwide Inpatient Sample, the largest all-payer inpatient care database in the U.S. The team identified how frequently the subjects were treated with either of the two methods:
retrograde ureteral catheterization (RUC)- drains blocked urine, and reduces pressure on the kidney, by inserting a catheter through the ureter
percutaneous nephrostomy (PCN)- the patient's back and kidney are pierced using a surgical tool

After 10 years of analysis, they found an increase in the prevalence of infected urolithiasis in females from 15.5 per 100,000, to 27.6, and in men, the increase was 7.7 per 100,000, to 12.1.

Related sepsis increased from 6.9% of urolithiasis patients to 8.5%, and severe sepsis rose from 1.7% to 3.2%.

Although increased rates of sepsis, severe sepsis, and prolonged hospital stays were found to be linked to PCN, the team noted that important variables needed for comparison have not yet been looked into.

Presumptions that might guide future treatment strategies would be speculative, the researchers explained, "demonstrating the pressing need for further study."

Sitting For Long Periods Increases Risk Of Kidney Disease

Individuals who sit for several hours of the day not only put themselves at risk for obesity and sore limbs, but also increase their chances of developing kidney disease.

Thomas Yates, MD, of the University of Leicester and the University Hospitals of Leicester NHS Trust and leading researcher in this study, said:




"It is currently not known how sedentary time or physical activity directly impact kidney health, but less sitting and more physical activity is associated with increased cardiovascular health through improvements to blood pressure,cholesterol, glucose metabolism, and arterial health. While this study confirms the growing body of literature that supports a link between lifestyle factors and the development of chronic kidney disease, it also adds to the evidence that simply sitting less may have important health benefits."




However, the results, which were published in the American Journal of Kidney Diseases, the official journal of the National Kidney Foundation, showed significant gender differences.

According to the team, from the University of Leicester, exercise was connected to a lower incidence of kidney disease, but men were more likely to balance out the negative impact of sitting for long periods through exercise.

In other words, explained Dr. Yates, men who sit for long periods of time, for instance at the office from 9 to 5 every day, can improve their health, particularly their kidney function, if they take part in traditional moderate-to-vigorous intensity physical activity. This includes brisk walking, jogging, or running on the treadmill.

However, exercising to make up for the negative effects of sitting is not as effective for women as it is for men. Females need to focus more on reducing prolonged periods of sitting time.

More than 5,650 participants (ages 40 to 75) were analyzed for the final results, and put into groups based on two factors: how long they spent sitting each day and the amount of time they spent exercising.

After controlling for certain lifestyle factors, the risk of developing chronic kidney disease (CKD) was decreased by more than 30% in females who reported fewer than 3 hours of sitting time, compared to those who reported over 8 hours.

Males who reported fewer than 3 hours of sitting down saw a reduction of 15%. Men who were physically active for at least 30 minutes each day, reduced the risk of developing CKD by at least 30%. However, exercise had no significant impact on the results of the women.

Previous research indicated that both male and female patients who are diagnosed with CKD can benefit from exercising regularly. For example, they will see improved physical fitness, healthier blood pressure, healthier heart rates, and better nutritional characteristics, compared to those who do not exercise.

Since this current study is the first of its kind to show a link between sitting for a long period, independent of exercise, with an increased risk of kidney disease, more research needs to be done to better understand the relationship.

There had been several studies examining the impact exercise has on health. It has previously been linked to a lower risk of coronary artery disease, type 2 diabetes, breast cancer, andcolon cancer. One particular study in Archives of Dermatology showed a link between physical activity and reduced risk of psoriasis.

Dr. Yates suggested that in order to improve the quality of kidney disease management programs, physical activity and reducing sitting time should be incorporated.

Dr. Kerry Willis, National Kidney Foundation Senior Vice President for Scientific and Medical Activities, said:




"This study is important because kidney disease is one of the most common chronic diseases. Twenty six million Americans are affected and millions more worldwide. Kidney disease prevention and treatment should include a lifestyle intervention such as physical activity and reduced sedentary behavior, in addition to careful control of blood pressure and lipid levels."

Genetic Link Found In Children With Kidney Defects And Neurodevelopmental Disorders

Mutations present in children born with kidney defects are known to cause neurodevelopmental delay or mental illness, according to new research appearing in the American Journal of Human Genetics.

Around 10 percent of kids with kidney defects have these mutations in their genomes, also known to be associated with mental illness and neurodevelopmental delay.

Congenital urinary tract and kidney defects make up about 25 percent of all birth defects in the United States and are found in one in every 200 births.

At last, an analysis for genomic alterations will be included in standard clinical workup. Patients who have congenital kidney disorder, presently included in one group, will be put into subcategories according to their genetic mutations, resulting in a more specific diagnosis.

Kidney specialist Ali Gharavi, MD, associate professor of medicine at CUMC, associate director of the Division of Nephrology, and an internist and nephrologist at NewYork-Presbyterian Hospital says:




"If a physician sees a child with a kidney malformation, that is a warning sign that the child has a genomic disorder that should be looked at immediately because of the risk of neurodevelopmental delay or mental illness later in life. This is a major opportunity for personalizing medical care. As we learn which therapies work best for each subgroup, the underlying genetic defect of the patient will dictate what approach to take."




This study was a broad collaboration of CUMC and other medical centers worldwide. Up until this point, no studies have successfully connected congenital kidney disease with neurodevelopmental disorders.

Simone Sanna-Cherchi, MD, an associate research scientist in CUMC's Department of Medicine explains:





"If you talk to clinicians, they tell you that some of these kids behave differently. There has been a general assumption, though, that behavioral or cognitive issues in children with chronic illnesses such as kidney disease stem from the child's difficulty in coping with the illness. Our study suggests that in some cases, neurodevelopmental issues may be attributable to an underlying genomic disorder, not the kidney disease."




Nearly 20 percent of kidney defects come from big DNA mutations. The mutations identified by Drs. Gharavi and Sanna-Cherchi and their team, are in a class of mutations known as copy number variations (CNVs).

CNVs are DNA surplus copies or deletions only big enough to contain several genes. When CNVs are there, the "dose" of the impacted genes is either lower or higher than normal, possibly resulting in a health disorder.

Before successful techniques for identifying CNVs were developed, scientists believed that CNVs lead only a few health disorders. Now, tens of thousands of different CNVs have been found and linked to many disorders such as autism, Parkinson's disease, and schizophrenia.

In order to examine CNVs' involvement in congenital kidney defects, the researchers scanned the genomes of 522 participants with small and malformed kidneys. Around 17 percent of the patients had a CNV that looked to play a part in their kidney disorder.

In previous research of children with already discovered CNVs, many of the CNVs had been connected to developmental delays or mental illness. In this study, one in ten children had a CNV connected to mental illness or developmental delays.

Although they are uncertain why kidney malformations and neurodevelopment are occasionally connected, it is conceivable that the same genes that take part in kidney development are also involved in brain development, the authors suggest.

Congenital kidney disease could include hundreds of different genes. The exploration for CNVs in congenital kidney disease also shows that the genes contributing to the disease are much greater in number than predicted.

Dr. Gharavi said, "We thought we were going to find a few CNVs shared by many patients, but instead we found that virtually every patient with a CNV has a unique one. Virtually every patient has a unique condition that could not be diagnosed by a standard clinical evaluation."

Pregnant Women With Hypertension At Increased Risk Of Developing Chronic Kidney Disease

Pregnant women with hypertension are much more likely to develop chronic kidney disease compared to women without the condition reveals a recent study published in CMAJ (Canadian Medical Association Journal).

Hypertension is a medical condition also known as high blood pressure, it occurs when the arteries have a significant force of blood pushing up against the blood vessel walls. The condition can carry severe health risks for pregnant women and the fetus.

Hypertension during pregnancy is fairly common, with around 5 to 10% of pregnancies affected. Medication is available to lower blood pressure, however a previous study found that some of these drugs may be detrimental to the fetus in pregnant women.

Dr. I-Kuan Wang, Division of Nephrology, China Medical University Hospital, Taichung, Taiwan, and coauthors said:

"We found that women with hypertensive disorders during pregnancy were at higher risk of end-stage renal disease than women without complicated pregnancies,"


The study involved comparing the prevalence of kidney disease (end-stage renal disease) of 26,651 Taiwanese women who were pregnant with hypertensive disorders with 213,397 women without the condition.

The researchers found that women with hypertensive disorders were 11 times more likely to develop chronic kidney disease and 14 times more likely to develop end-stage renal disease.

"We found an increased risk of subsequent end-stage renal disease among Taiwanese women who had experienced hypertensive disorders during pregnancy, including preeclampsia or eclampsia and gestational hypertension," write the authors. "We also found that women with preeclampsia or eclampsia were at higher risk of end-stage renal disease than those who had gestational hypertension only."

There is scarce data to indicate a link between hypertension during pregnancy and increased risk of end stage renal disease. However, this study supports findings from a previous Norwegian study that found associations between hypertensive disorders and the development of kidney diseases.

The authors conclude:

"Close surveillance for microalbuminuria, blood pressure and diabetes should be considered for women with a history of hypertensive disorders during pregnancy. Preventive strategies, such as pharmacologic or lifestyle interventions, should also be considered for women at high risk of end-stage renal disease."

Dr. Julia Spaan from Maastricht University Medical Center, the Netherlands, and Prof. Dr. Mark Brown from the University of New South Wales, Australia add:

"This study by Wang and colleagues is timely because it shows the importance of hypertension during pregnancy as a marker for future chronic kidney disease, cardiovascular disease and diabetes.

It also highlights one of the current pitfalls of clinical practice: although these women have great attention paid to their high blood pressure during pregnancy, there is no structured follow-up of blood pressure or cardiovascular and renal risk factors after pregnancy. Better surveillance after pregnancy should help prevent not only chronic kidney disease but also cardiovascular disease."

Omontys, Anemia Drug For Kidney Dialysis Patients, Recalled

Omontys (peginesatide) Injection, a drug used for anemia treatment in kidney dialysis patients, has been recalled because of "serious, life-threatening or fatal hypersensitivity reactions", including anaphylaxis.

The voluntary recall has been announced by Takeda Pharmaceutical Co. and Affymax Inc.

The two companies have recalled all Omontys lots which are sold in 20mg and 10mg vials. Doctors have been told not to administer the medication to patients.

All lots of Omontys are affected by this recall:
10mg Multi-dose vials
Lots - C18685, C18881, C19258

20mg Multi-dose vials
Lots - C18686, C18696

Omontys (peginesatide), an erythropoietic agent, a functional analog of erythropoietin, was approved by the FDA (Food and Drug Administration) for anemia associated with chronic kidney disease in adult patients on dialysis. In December 2011, the FDA Advisory Committee (Oncologic Drugs Advisory Committee) voted 15 to 1 in favor with 1 abstention to approve peginesatide.

The FDA says that it has been informed about the recall and agrees with the voluntary measure taken by the two companies.

Takeda spokesman, Kazumi Kobayashi, said:

"Our company is working with the FDA and Affymax and decided to voluntarily recall Omontys to put patients' safety first. We will swiftly provide information to patients and health care professionals."




Fresenius Medical Care, USA, said it will halt the Omontys pilot program for the moment, after observing infrequent allergic reactions in patients after their first dose of the medication.

Out of approximately 25,000 patients taking Omontys, 0.02 have had fatal reactions after being administered their first dose., said Takeda. In about 1 in every 500 cases, hypersensitivity reactions (anaphylaxis) have been serious enough to require the attention of a doctor - some of the patients had to be admitted to hospital.

According to a Takeda communiqué, "serious hypersensitivity reactions have occurred within 30 minutes after such administration of Omontys." The company emphasized that there have been no reports of such reactions after subsequent administrations of drug. In other words, the reactions of concern only occur after the first application of the drug, not second, third, etc.

Takeda says that customers will receive instruction on how to return the medication to the manufacturer for a full refund. If you are a customer and have any queries, you are invited to telephone 1-855-466-6689. The helpdesk is staffed from 9am to 5pm Monday to Friday, Eastern Standard Time.

The FDA invites patients and healthcare professionals to report reactions or quality problems related to Omontys usage to the Agency's MedWatch Adverse Event Reporting program either:
By fax - 1-800-FDA-0178
Online at www.fda.gov/medwatch/report.htm
Regular mail. Use a postage-paid, pre-addressed Form FDA 3500. Mail to the pre-addressed details on the form. The form is available

Takeda has been desperately trying to find a blockbusting drug to make up for the drop in sales after its diabetes medication, Actos, lost patent protection last year. Actos has also become the target of lawsuits.

Actos users' legal representative allege that Takeda either downplayed or ignored concerns regarding the medications potential for causing cancer before it was approved by the FDA in 1999 - Takeda is being accused of misleading the FDA about the medication's risks.

Written by Christian Nordqvist

Stronger Statin Doses Tied To Kidney Injury

A new study finds that high potency statins are tied to higher risk of being hospitalized for acute kidney injury compared with less potent statins and that the risk persists for two years.

Lead researcher Colin Dormuth, of the University of British Columbia, in Vancouver, Canada, and colleagues, write about their findings in a BMJ paper that was published online on 19 March.

Statins are a widely-used class of drug for lowering cholesterol as a way to reduce the risk of cardiovascular disease, with higher doses prescribed for those at higher risk.

Largely as a result of clinical trials showing improved cardiovascular outcomes, there has been a trend toward increasing the potency of statins, either with larger doses, such as simvastatin or atorvastatin 40-80 mg, or with the more potent form, rosuvastatin.

But researchers are beginning to suggest that increasing potency may lead to adverse kidney problems, and because statins are so widely used, concerns are being raised about these adverse events.

Clinical trials don't involve large numbers of people, so adverse side effects may not be common enough to be identified, and it is only in postmarketing monitoring, and analyses of large groups of patients, that they begin to show.

For this latest study, researchers from across Canada compared patients who were prescribed high potency statins to those who were prescribed low potency statins in seven Canadian provinces and two international databases (UK and US) between 1997 and 2008.

They used the health records of 2 million people from the Canadian Network for Observational Drug Effect Studies (CNODES) to assess the link between treatment with high versus low potency statins and hospitalization for acute kidney injury in patients with and without chronic kidney disease.

All patients were age 40 and over: the average age was 68.

High potency was defined as rosuvastatin at doses of 10mg or higher, atorvastatin at doses of 20mg or higher, and simvastatin at doses of 40mg or higher. All others were defined as low potency.

When they analyzed the data, the researchers found that high potency statin users were 34% more likely to be hospitalized for acute kidney injury compared with low potency statin users in the first 120 days of treatment.

And the risk remained higher for two years after starting treatment.

Rates were not significantly increased in patients with chronic kidney disease.

Expressing the results in another way, the researchers estimate that for every 1,700 patients without chronic kidney disease treated with a high potency as opposed to a low potency statin, there is one additional hospitalization for acute kidney injury.

Although they suggest clinicians take this apparent elevated risk into account when low potency statins are an option, the researchers also recommend further studies be done to look more closely at the links between statin use and kidney injury.

In an editorial, Robert G Fassett and Jeff S Coombes, professors at the University of Queensland Australia, also call for further studies, particularly comparing the effects of strong and weak statin doses.

And they say more research is needed on the various causes of acute kidney injuries that lead to hospitalization.

A Danish study published in 2012 found that statins were tied to reduced cancer deaths: people who regularly used statins to lower cholesterol and then received a cancer diagnosis were 15% less likely to die from cancer or any other cause.

Why Apple-Shaped People Have Higher Risk Of Kidney Disease

A new study may help explain why being "apple-shaped", that is carrying excess weight around the middle, is more closely linked with kidney disease than being pear-shaped, regardless of BMI. Researchers in the The Netherlands found that people with apple-shaped bodies are more likely to have poorer kidney function, plus lower blood flow and higher blood pressure in the kidneys.

Arjan Kwakernaak and colleagues, of the University Medical Center Groningen, report their findings in the 11 April online before print issue of the Journal of the American Society of Nephrology (JASN).

Scientists already know that carrying excess fat around the middle is more closely linked to kidney disease than carrying it around the hips, but the underlying mechanisms are not well understood.

Kwakernaak and colleagues set out to examine what these mechanisms might be by looking at waist-to-hip ratios (WHRs) and measures of kidney health ("renal hemodynamics") in 315 healthy people with an average body mass index (BMI) of 24.9 kg/m2.

A BMI between 18.5 and 24.9 kg/m2 is considered normal weight, and WHR is a measure of how much body fat is carried around the middle (central adiposity).

The researchers found that the more apple-shaped a person was (higher WHR), the lower their kidney function (as measured by GFR), plus the lower their kidney blood flow and the higher their kidney blood pressure, even after taking into account possible influencing factors.

"WHR was associated with lower GFR, lower effective renal plasma flow, and higher filtration fraction, even after adjustment for sex, age, mean arterial pressure, and BMI," write the authors.

Glomerular filtration rate (GFR) is the volume of fluid the kidneys can filter in a given amount of time. It is used to assess the excretory function of the kidneys.

Kwakernaak says in a press statement:

"We found that apple-shaped persons -- even if totally healthy and with a normal blood pressure -- have an elevated blood pressure in their kidneys. When they are also overweight or obese, this is even worse."

He and his colleagues suggest it is the elevated blood pressure in the kidneys that may explain why apple-shaped people have a higher risk for kidney disease later in life.

They propose such individuals may benefit from treatments that reduce blood pressure in the kidneys.

Previous studies have suggested restricting salt intake can reduce kidney blood pressure, as can drugs that help regulate the "renin-angiotensin-aldosterone system".

"Our current data suggest that such interventions could be particularly useful in subjects with a central body fat distribution," says Kwakernaak.

Meanwhile, a UK study published online a week earlier in JASN, found that being overweight starting in young adulthood may significantly increase individuals' risks of developing kidney disease by the time they become seniors.

Lab-Grown Kidney Transplanted Into Rats Produces Urine

US scientists have grown kidneys that produce rudimentary urine in the lab and also after being transplanted into rats. They hope to refine the approach so one day it is possible to grow human kidneys in the lab that work as well as donor kidneys in transplant patients but without the need for them to take drugs to suppress their immune system.

The unique approach does not grow a kidney totally from scratch but strips the cells from the old, failed kidney, leaving a 3D honeycomb scaffold of the correct shape, and then repopulates it with donor kidney and blood vessel cells to produce a new, working kidney.

This approach has already been used to bioengineer hearts, lungs and livers, but kidneys, which filter the blood to remove toxic waste products for elimination, are one of the most complex organs of the body, and this is the first time scientists have successfully bioengineered one that works.

The new study shows the lab-grown kidneys do not perform as well as original, healthy ones, but with refinement the approach shows great promise, say the researchers, who write about their work in a paper published online this week in Nature Medicine.

Senior author Harald Ott, of the Center for Regenerative Medicine at Massachusetts General Hospital in Boston, says in a statement:


"What is unique about this approach is that the native organ's architecture is preserved, so that the resulting graft can be transplanted just like a donor kidney and connected to the recipient's vascular and urinary systems."

"If this technology can be scaled to human-sized grafts, patients suffering from renal failure who are currently waiting for donor kidneys or who are not transplant candidates could theoretically receive new organs derived from their own cells."
Many Patients Waiting for New Kidney

Although around 18,000 kidney transplants are performed in the US every year, more than five times this number of Americans with end-stage kidney disease are on the waiting list for a donor organ.

Even when they receive a donor organ, kidney recipients face a lifetime of taking special drugs to stop their immune system rejecting it. This can seriously affect their health, and still doesn't totally remove the chance their body will eventually reject the donor organ.

If the kidney were made of their own cells, they wouldn't need to take immunosuppressive drugs.
First Prepare the Scaffold, then Populate It With Donor Cells

Ott and colleagues carried out a study in two parts. The first was about successfully stripping out cells to make a viable scaffold, and the second was about creating a functional organ.

For the first part, they stripped the living cells from the donor organ with a detergent solution, leaving a 3D, collagen scaffold of the correct shape and size, with the organ's complex and intricate architecture intact.

They did this with rat kidney, and then moved onto pig and human kidneys and showed it was possible to scale up the process and strip out cells from the larger organs to leave a viable scaffold, with all the organs' complex structures intact.

For the second part, the researchers seeded the rat kidney collagen scaffold with human endothelial cells to re-line the stripped out vascular system, and kidney cells (cortical and medullary) from newborn rats to make the functional kidney tissue.

One of the challenges was making sure the appropriate cells went to their rightful places. This involved delivering the vascular cells (to reline the cavities of the stripped out blood vessels) through the renal artery, and the kidney tissue cells through the ureter.

They had to get the solution pressures for delivering the cells just right, or they wouldn't disperse through the whole organ.

They then placed the seeded organ to "grow" in a bioreactor for up to 12 days.
Bioengineered Kidneys Capable of Rudimentary Urine Production In the Lab and In Live Rats

To test how well the bioengineered organ performed, they connected it to a system that passed blood through the newly formed blood vessels, and then drained off any "urine" the organ produced.

They found that the while the "urine" was far from perfect, there was evidence that the new organ was trying to filter the blood.

The researchers also transplanted bioengineered kidneys into live rats that had had one kidney removed. They found the engineered organs started producing urine as soon as they were connected to the rats' blood supply, with no bleeding or blood clots.

Again, the kidney function of the engineered organs was far from perfect, compared to normal healthy organs. The researchers say this could be because they used cells from newborn rats to repopulate the scaffolds, and believe a more functional organ could be made by changing the cell types used for seeding and also by improving the maturation process in the bioreactor.
Ideally, Bioengineered Organs Should Be Possible "On Demand" from Patients' Own Cells

Ott says while their study is an initial "proof of principle", he hopes one day we will see fully functioning bioengineered kidneys being used in the same way as donor organs.

"In an ideal world, such grafts could be produced 'on demand' from a patient's own cells, helping us overcome both the organ shortage and the need for chronic immunosuppression," he adds.

The team is now looking at ways to get the correct cell types from patients themselves, and also to improve the seeding process and upscaling the organ growing system to handle human-sized kidneys.

Funds from the National Institute of Health Director's New Innovator Award helped pay for the study.

In another recent study, UK researchers show how it may be possible to grow a bioengineered teeth from gum cells as an alternative to implanting false ones.

The Correct Diet Can Help Avoid Kidney Disease

Bad diet choices and habits like smoking and obesity are linked to an increased risk for kidney disease, suggests a new study published in theAmerican Journal of Kidney Disease.

A group of investigators, led by Alex Chang, MD, of Johns Hopkins University, discovered that people with regular kidneys whose diet quality was bad - high in processed and red meats, sodium, and sugar-sweetened beverages, and low in fruit, nuts, legumes, whole grains, and low-fat dairy - were more likely to develop kidney disease.

Just one percent of people without unhealthy diet or lifestyle choices developed protein in their urine - an early sign of kidney damage. On the other hand, 13% of participants who had at least three unhealthy factors such as obesity, smoking, and poor diet developed protein in their urine.

Obese people, i.e. those with a body mass index (BMI) of at least 30, were twice as likely to develop kidney disease, the authors reported. A poor diet independently influenced risk forchronic kidney disease after adjusting for weight and other influential factors.

The investigators also pinpointed a link between those who currently smoke and the development of chronic kidney disease. Smokers were found to be 60% more likely to develop kidney disease.

In the first study conducted on this topic, researchers analyzed kidney disease risk factors in healthy young people using longitudinal data ranging over 15 years, including information on more than 2,300 black and white adults aged between 28 and 40 years from the Coronary Artery Risk Development in Young Adults (CARDIA) Study.

Dr. Chang said:

"Unlike family history of kidney disease, diet, smoking, and obesity are modifiable lifestyle factors that we can all control. By eating well, quitting smoking, and maintaining a normal weight, people can protect their kidneys and prevent future damage."

In total, those who ended up with kidney disease were more likely...

·to be African American

·to have high blood pressure

·to have diabetes

·to have a family history of kidney disease

·have a higher intake of soft drinks, fast food, and red meat

...compared to those who did not have kidney disease.

Dr. Beth Piraino, National Kidney Foundation President explained:


"In the United States, 26 million adults are living with chronic kidney disease. We need to shift the focus from managing chronic kidney disease to preventing it in the first place. Using this study as evidence, we can encourage changes in individual lifestyle choices and behaviors, and ultimately prevent people from developing kidney disease."

The National Kidney Foundation has the following guidelines to reduce the risk of developing kidney disease:

·Reduce sodium intake: Americans consume too much sodium (salt)

·Limit red meat: Diets high in protein - especially those with animal protein - may harm the kidneys. Red meat is also high in saturated fat.

·Avoid soda: Sugar-sweetened drinks, like sodas, are high in calories and contain no nutritious value. Additionally, colas have phosphorus additives which can damage kidneys.

·Give up processed foods: Potato chips, crackers, cheese spreads, instant potato mix, and deli meats are all examples of processed foods that are high in phosphorus additives and sodium - both of which can have a damaging effect on the kidneys.

·Reduce sugar intake: Consuming too much sugar can result in diabetes or obesity - both linked to kidney disease.

Kidney disease kills more than 90,000 Americans annually - more than breast or prostate cancer.

A previous study from 2009 stated that obese people with prehypertension are at an increased risk for kidney disease.

What Is Dialysis? What Is Kidney Dialysis?

Dialysis is the artificial process of eliminating waste (diffusion) and unwanted water (ultrafiltration) from the blood. Our kidneys do this naturally. Some people, however, may have failed or damaged kidneys which cannot carry out the function properly - they may need dialysis.

In other words, dialysis is the artificial replacement for lost kidney function (renal replacement therapy).

Dialysis may be used for patients who have become ill and have acute kidney failure (temporary loss of kidney function), or for fairly stable patients who have permanently lost kidney function (stage 5 chronic kidney disease).

When we are healthy our kidneys regulate our body levels of water and minerals, and remove waste. The kidneys also produce erythropoietin and 1,25-dihydroxycholecalciferol (calcitriol) as part of the endocrine system. Dialysis does not correct the endocrine functions of failed kidneys - it only replaces some kidney functions, such as waste removal and fluid removal.

Dialysis and altitude - A study found that death rates for dialysis patients are 10%-15% lower for those whose homes are higher than 4,000 feet, compared to those who live at sea level.

Some countries, such as the UK, are predicting a doubling of the number of patients on dialysis machine.
Why is dialysis necessary?

Approximately 1,500 liters of blood are filtered by a healthy person's kidneys each day. We could not live if waste products were not removed from our kidneys. People whose kidneys either do not work properly or not at all experience a buildup of waste in their blood. Without dialysis the amount of waste products in the blood would increase and eventually reach levels that would cause coma and death.

Dialysis is also used to rapidly remove toxins or drugs from the blood.
There are two main types of dialysis - hemodialysis and peritoneal dialysis

What type of dialysis a patient should have really does depend on each individual case. Studies have indicated clearly that for kidney disease patients who need to undergo dialysis, one type of treatment is not best for all.

What is hemodialysis?

The blood circulates outside the body of the patient - it goes through a machine that has special filters. The blood comes out of the patient through a catheter (a flexible tube) that is inserted into the vein. The filters do what the kidney's do; they filter out the waste products from the blood. The filtered blood then returns to the patient via another catheter. The patient is, in effect, connected to a kind of artificial kidney.

Honey no better than antibiotics in patients with kidney failure

A trial published in The Lancet Infectious Diseases shows that applying medical grade honey to wounds of patients undergoing dialysis does not have an advantage over normal antibiotic use.

Researchers say this finding will come as a disappointment to clinicians, some of whom hoped honey would offer a better substitute for antibiotics.

Peritoneal dialysis is a procedure used to clean the blood of patients who have kidney failure. It is carried out by inserting a catheter into the peritoneum - a thin membrane surrounding organs in the abdomen.

This procedure is used in over 200,000 patients with kidney failure each year around the world, researchers say. However, it carries with it risks of infection at either the site of the catheter insertion or in the peritoneum, which is called peritonitis.

Sometimes a life-threatening infection, peritonitis is usually treated with antibiotics, but the researchers say only a narrow range of infections are covered by the types of antibiotics that doctors are able to use in such situations.

And overuse of antibiotics is contributing to antibiotic resistance. Medical News Today recently reported that bacteria speak a "universal language" to build up antibiotic resistance.
Honey hopes dashed

The researchers say that antibacterial honey has previously shown promise as a new, cheap and effective "prophylactic agent" that does not promote resistance from microbes.

Medical grade honey is made by sterilizing standard honey.

As a result of the encouraging findings around the bee-made compound, researchers in Australia set out to test how honey performed when applied each day to the wound sites of patients receiving peritoneal dialysis.

The team compared this with a standard antibiotic treatment that is applied nasally, called mupirocin.

In the trial, 371 patients were recruited from 26 medical centers in both Australia and New Zealand. Of these patients, 186 received a daily application to the site of the catheter insertion of 10 mg of medical grade honey.

The control group consisted of 185 patients who were tested for nasal carriage ofStaphylococcus aureus and treated with the mupirocin if they tested positive. If they tested negative, they received standard wound care.

There was no significant difference in the average time to first infection between the honey and control groups. Patients in the honey group had an average of 16 months until their first infection, while the control group showed an average of 17.7 months.

Additionally, the first time to infection in patients with diabetes was much sooner in the honey group, at 11.6 months on average. Plus, the risk of peritonitis was nearly twice as high, compared with diabetic patients in the control group.
Avoiding infection in the first place 'is key'

As a result of the findings, the researchers say that they cannot recommend honey for the prevention of infections related to peritoneal dialysis.

Professor David Johnson, of the Australasian Kidney Trials Network, says that they had a high rate of patient withdrawal from the honey group, at either the request of the patient or physician.

"This suggests that patients may have found the daily application of honey to the wound site uncomfortable or inconvenient," he says.

In a comment paper on the study, Professors Achim Jörres and Wim van Biesen note that the discouraging effectiveness of honey may not be completely due to the honey's properties as an antibacterial agent:

"Although the results of [this study] show the efficacy of mupirocin versus Medihoney, the important question of whether patients with a healthy catheter exit site for peritioneal dialysis should receive prophylactic treatment remains to be addressed."

Young transplant patients 'at higher risk of kidney disease

A new national study from US researchers suggests that children who undergo solid organ transplants are at higher risk of developing advanced kidney disease.

Researchers from the Children's Hospital of Philadelphia and the University of Pennsylvania say their findings emphasize the importance of continued kidney screening in pediatric transplant patients.

The researchers used data from the Scientific Registry of Transplant Recipients, analyzing the records of 16,604 children in the US between 1990 to 2010 who received solid-organ transplants (liver, heart, lung, intestine and heart-lung). All participants were followed for an average of 6.2 years.

According to the researchers, this was the first pediatric study comparing the relative incidence of end-stage kidney disease (ESKD) by type of organ transplant, and the first to analyze the risk of advance kidney disease among pediatric solid-organ recipients over a 20-year period.

Results of the study, published in the journal Pediatrics, showed that 426 (3%) children who underwent solid-organ transplants had higher risk of developing end-stage kidney disease (ESKD).

The highest risk was apparent in children who underwent intestinal or lung transplants, with a hazard ratio of 7.37 and 5.79 per 1,000 person-years respectively, while the lowest risk of ESKD was for children who received liver transplants.

The researchers note that, by contrast, liver transplants in adults are linked to the highest risk of ESKD, while adult lung transplants pose the lowest risk.

Rebecca L. Ruebner, pediatric nephrologist at the Children's Hospital of Philadelphia and study author, says:

"We found that the risk patterns for kidney disease are different among patients who receive solid-organ transplants as children, compared to adult transplant recipients.

Because chronic and end-stage kidney disease carry high burdens of mortality and serious illness, it is important to take preventive measures to slow or prevent disease progression."

According to the US Department of Health and Human Services, last year 1,077 US children aged between 1- and 10-years-old received organ transplants.

Dr. Ruebner notes that although the overall incidence of ESKD was only 3% in pediatric solid-organ transplant recipients, the burden of chronic kidney disease is much higher.

"Children with chronic kidney disease experience a steady decline in kidney function," she adds, "so we recommend that pediatric healthcare providers carefully follow post-transplant patients to detect any early signs of kidney problems, with early referral, if necessary, to a pediatric nephrologist."

Medical News Today recently reported on the creation of an artificial kidney, which could help patients suffering from chronic renal failure.

Citrus fruits may prevent kidney cysts

Scientists have discovered that a component found in grapefruit and other citrus fruits may successfully block the development of kidney cysts, according to a study published in theBritish Journal of Pharmacology.

Researchers from the Royal Holloway University, St. George's, the University of London and Kingston University London in the UK, say that the component, called naringenin, could be used to develop new drugs for the treatment of polycystic kidney disease.

It is an inherited disorder that causes cyststo develop in the kidneys. The disease can lead to loss of kidney function, high blood pressure leading to heart attack and stroke, as well as brain aneurysms. Onset is most common between the ages of 30 and 60.

According to the American Kidney Fund, more than 600,000 people in the US suffer from polycystic kidney disease - the most common form of the disease being autosomal dominant polycystic kidney disease (ADPKD).
Naringenin regulates PKD2 protein


For their research, the team conducted an experiment on a single-celled amoeba containing a protein called PKD2. This is the protein responsible for the development of polycystic kidney disease.

It was discovered that when naringenin came into contact with the PKD2 protein, it became regulated, blocking the formation of cysts.

Researchers say that a component found in citrus fruits, called naringenin, may successfully block the development of polycystic kidney disease.

To see how this discovery could apply to treatments of polycystic kidney disease, the scientists triggered the formation of cysts in a mammalian kidney cell-line.

It was found that the formation of cysts were blocked by adding naringenin. Furthermore, when levels of the PKD2 protein were reduced in the kidney cells, the block in cyst formation was also reduced. This confirmed that the effect was connected.

"This discovery provides an important step forward in understanding how polycystic kidney disease may be controlled," says Professor Robin Williams of the School of Biological Sciences at Royal Holloway University.

Dr. Mark Carew, of the School of Pharmacy and Chemistry at Kingston University, says that further research is underway in order to understand exactly how naringenin works at a molecular level.

"This work will entail looking at the function of the PKD2 protein as a cell growth regulator," he adds.

Prof. Williams notes that their new approach to testing components, such as naringenin, may reduce reliance on animal testing in the development of new therapies:


"In the study, we have demonstrated how effective the amoeba Dictyostelium is in the discovery of new treatments and their targets.

Having previously applied the same method of testing in our work into epilepsyand bipolar treatments, it is clear that this new approach could help us reduce reliance on animal testing and provide major improvements."

Last year, Medical News Today reported on a study suggesting that citrus fruits may reduce the risk of stroke in women.

Written by Honor Whiteman