Kidney disease, chronic infectious diseases

Anemia of chronic disease is a hypoproliferative anemia associated with chronic infectious or inflammatory processes, tissue injury, or conditions that release proinflammatory cytokines. The pathogenesis is based on shortened RBC survival, impaired marrow response, and disturbance of iron metabolism. For information on anemia of chronic kidney disease, see Chap. 76. 

Infectious disease studies are normally conducted over a short time, providing only snapshots and do not provide information on the consequence of chronic immunosuppression. The adverse health effects of chronic, low level immunosuppression have been addressed to some extent in transplant patients, primarily kidney transplants, who demonstrate an increase frequency of certain immunogenic tumors. 

Indications Latter stages of warm diseases, yin fluids consumed and damaged, evils hidden in the yin division. Advanced stages of various infectious diseases, pulmonary tuberculosis, chronic nephritis, kidney tuberculosis, fevers of unknown etiology, typhoid fever convalescence, and post-surgical fevers... 

It has also been observed that chronic lymphocytic inflammation from other underlying disease causes the prion protein to be expressed in otherwise prion-free tissues (Heikenwalder et al., 2005), which might have significant implications for the potential infectivity of non-neural tissues. For example, while the prion protein is not normally excreted in urine, chronic inflammatory kidney disease does result in ptionuria in PrP "-infected mice. Inoculation of noninfected mice with urinary PrP produced scrapie (Seeger et al., 2005), which might be a source of horizontal prion infectivity in animal populations, such as the epidemic of CWD in North American deer and elk. Infectious prions have also been detected in the saliva of CWD-positive deer and may contribute to the spread to other individuals (Mathiason et al., 2006). The stability of infectious prions in soil, possibly for years, indicates a potential for an environmental reservoir of prions (Brown and Gajdusek, 1991 Johnson et al., 2006). 

Infection risk The risk of infections and serious infections with rituximab may be similar to that with the TNT antagonists. To date, there have been no reports from trials of an increased risk of tuberculosis or opportunistic infections with rituximab [162 ]. Some investigators have reported an increase in Pneumocystis jirovecii pneumonia, and increased number of infections has been documented in patients treated with maintenance rituximab for low-grade lymphoma and in patients with concomitant severe immunodeficiency, whether caused by HIV or immunosuppressive agents [152 ]. In rheumatoid arthritis, the susceptibility factors for severe infections include chronic lung and/or cardiac disease, extra-articular involvement, and low IgG before rituximab treatment [163 ]. After kidney transplantation, the off-label use of rituximab is associated with a high risk of infectious disease and death related to infectious disease [164 ]. 

Biofilms play key roles in several chronic human infections including infectious kidney stones, bacterial endocarditis, and cystic fibrosis lung infections, and the roles of biofilm formation in these diseases have been reviewed [27]. Biofilms also serve as environmental reservoirs for... 

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