Kidneys and How They Function Term Paper

  • Length: 8 pages
  • Sources: 3
  • Subject: Anatomy
  • Type: Term Paper
  • Paper: #33287328

Excerpt from Term Paper :

However, Harvard Medical School (HMS) reports that in that study of 1,400 patients, 222 "composite events occurred." Those "events" included 65 deaths, 101 "hospitalizations for congestive heart failure, 25 myocardial infarctions and 23 strokes."

In an understatement, the HMS report - written by Dr. Singh - concluded that while improving the lives of patients with CKD is "of paramount importance," this particular study reveals, "...Aiming for a complete correction of anemia is associated with increased risk, increased cost and no quality of life benefits." The study was published in the November 16, 2006 issue of the New England Journal of Medicine.

Meantime, the National Institutes of Health / Medline Plus (www.nim.nih.gov) explains that epoetin alfa is also used with people who have HIV, it is used prior to surgery and after surgery "to decrease the number of blood transfusions needed" in the predicable loss of blood during surgery. It is also used to treat people who have been weakened by chemotherapy. Epoetin Alfa is "usually injected one to three times weekly" subcutaneously in patients who have a lower than normal number of red blood cells (i.e., anemia), albeit it does not "cure anemia" and it frequently takes from two to six weeks before it actually shows an increase in red blood cells.

While the HMS report asserted that a number of deaths and heart attacks occurred when patients with CKD were given high doses of Epoetin alfa, the National Institutes of Health warn, "Some side effects can be serious." Notably, there can be hallucinating, fever, a spreading rash all over the body, "hives...wheezing, difficulty breathing or swallowing," along with pain, numbness and tingling in the hands and feet, indigestion, vomiting, diarrhea, nausea, sever itching at the injection spot, and the sensation of "...feeling clod most of the time."

Meanwhile, an article in the journal Annals of Internal Medicine (Palmer, et al., 2007) reports on research involving the use of Vitamin D compounds as therapy for patients with CKD. In the research, 3,667 patients were enrolled in seventy-six different trials. The study was conducted because solutions are being sought constantly to reduce the pain and agony that patients with CKD (and those with diabetes associated with CKD) suffer with on an international level. The researchers reported at the outset that CKD is associated with "significantly increased rates of all-cause and cardiovascular mortality."

Further, Palmer writes, that over the past twenty years some solutions have been sought that resulted in death or failure to improve the conditions in patients. The research used placebo and Vitamin D compounds with patients who had "any stage of CKD" and the trial results were reviewed by two independent authors, both of whom extracted data on the characteristics of the participants, the previous interventions, comparisons with other CKD patients and clinical outcomes of previous interventions, when they had been reported. The upshot of these trials on 3,667 patients was that Vitamin D "...did not reduce the risk for death, bone pain, vascular calcification or parathroidectomy."

In fact in eight of the 76 trials at least one person died; and Vitamin D compounds do not "consistently reduce PTH levels." Further, the value of using Vitamin D compounds for people with CKD "remains uncertain," Palmer concludes.

Eschewing antirejection drugs after a kidney transplant. There is better and more positive news regarding research into kidney failure, according to the February 2008 feature "Focus Online" (http://focus.hms.harvard.edu).In 2007, for the first time, a medical team that conducted a kidney transplant reported a "stable" kidney function following a deliberate withdrawing of antirejection drugs from patients. Indeed, transplanted kidneys in four of the five people receiving kidney transplants - from "close but immune-mismatched relatives" (Morton, 2008) - in this report have survived for between two and five years without the strong antirejection drugs being administered.

How this was done is very heartening and encouraging for medical science, the report explains. Most recipients must take strong drugs for the remainder of their lives, because the body tends to reject kidneys; there are very few "genetically identical donors" and hence, the drugs must be taken to prevent the body from attacking the transplanted organs, Morton explains. And those drugs themselves "...take a toll by promoting infections and cancer," the Focus report written by Carol Cruzan Morton continues. This is the very first time, the article insists, that intentionally the recipient was taken off drugs following "well-done mouse and monkey studies."

Basically what happened to help the donor avoid the potentially cancer-causing antirejection drugs was this: the kidney recipient's bone marrow and the donor's bone marrow are mixed together "long enough to trick the immune system into tolerating the donor organ forever," Morton writes. In order to mix the bone marrow specimens thoroughly, the medical team used chemotherapy to "partially destroy the patient's bone marrow." Also, they used an antibody "...targeted to mature T cells, and radiation of the thymus."

Later in the lab, researchers on the team from Massachusetts General Hospital verified that the donor's bone marrow engrafted properly and as a result produced "...a full lineage of blood and immune cells for less than a month, before all evidence of donor cells vanished."

Another positive report for patients with kidney dysfunction was issued by the Harvard Medical School in 2005; a large-scale analysis indicates that a specific blood test that was previously discovered to be useful in either diagnosing or ruling out heart failure in emergency room patients is also, contrary to previous research, effective for patients with CKD who have heart problems. It is well-known that congestive heart failure - this happens when an impaired heart muscle "cannot pump blood efficiently" (according to (www.hms.harvard.edu)- is an enormous health problem in America. But in order to diagnose heart failure properly and accurately, it is tricky because the symptoms "can overlap those of other conditions." The use of the blood marker test called NT-proBNP can not only identify patients who have an immediate high risk of death from heart failure, the research has found, but also can give accurate indications of patients with chronic kidney disease whose hearts are struggling to survive.

What we don't understand about kidney failure. It is not known why kidney failure occurs more often in certain ethnic groups like African-Americans, American Indians, Latinos (and Hispanics) than among Caucasians. Scientists also are at a loss to fully explain why factors like diet, heredity, and high blood pressure increase the risk that a person with diabetes will ultimately experience kidney failure. They do know these factors can lead to kidney failure, but they do not know why.

Works Cited

Harvard Medical School. (2005). Blood test can accurately diagnose heart failure in patients

With kidney dysfunction. Retrieved February 10, 2008, at http://www.hms.harvard.edu.

Harvard Medical School. (2006). Higher Doses of Anemia Drug for Chronic Kidney Disease

Does Not Improve Quality of Life and Increases Risk for Cardiovascular Events. Retrieved February 9, 2008, at http://www.hms.harvard.edu.

Mark, Roger G. (2004). Quantitative Physiology: Organ Transplant Systems. Renal Physiology.

Massachusetts institute of Technology and the Harvard-MIT Division of Health, Sciences and Technology.

Medline Plus. (2007). Why is Epoetin Alfa Prescribed? Retrieved February 10, 2008, at http://www.nim.nih.gov.

Morton, Carol Cruzan. (2008). Transplantation Medicine; Mismatched Kidney Transplant

Succeeds Without Immunosuppression. Focus Online. Harvard Medical School. Retrieved February 10, 2008, at http://focus.hms.harvard.edu.

National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). (2007). Kidney

Disease of Diabetes. Retrieved February 9, 2008, at http://kidney.niddk.nih.gov/kudiseases/pubs/kdd/index.htm.

Palmer, Suetonia C.; McGregor, David O.; Macaskill, Petra; Craig, Jonathan C.; Elder,…

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