Renal prognosis

Davenport A, Maciver AG, Hall CL, MacKenzie JC. Do mesangial immune complex deposits affect the renal prognosis in membranous glomerulonephritis Clin Nephrol 1994 41(5) 271-6. 

Antihypertensive treatment has improved renal prognosis and survival in diabetic nephropathy... 

Criteria for initiation of drug treatment now take into consideration total cardiovascular risk rather than blood pressure alone, such that treatment is now recommended for persons whose blood pressure is in the normal range but still bear a heavy burden of cardiovascular risk factors. Thus, the role of simultaneous reduction of multiple cardiovascular risk factors in improving prognosis in hypertensive patients is stressed. In addition, more aggressive blood pressure goals are recommended for hypertensive patients with comorbid conditions such as diabetes mellitus or renal insufficiency. 

Metastatic renal cell carcinoma has a poor prognosis and resists conventional chemotherapy. Immunotherapy with IL-2 and/or IFN-a is currently regarded as the most effective therapy with, however, modest response rates of 15-20%. Similar results are also observed in patients with metastatic melanoma and the response to IFN-a and IL-2 correlates with the occurrence of tumor-infiltrating CD4+ T-lymphocytes identified in aspirates from melanoma metastases. Determination of these cells therefore seems to be a method to predict responders prior to the initiation of cytokine therapy. 

There is growing evidence of a link between renal disease and HF.8 Renal insufficiency is present in one-third of HF patients and is associated with a worse prognosis. In hospitalized HF patients, the presence of renal insufficiency is associated with longer lengths of stay, increased in-hospital morbidity and mortality, and detrimental neurohormonal alterations. Conversely, renal dysfunction is a common complication of HF or results from its treatment. Renal failure is also a common cause for HF decompensation. 

The prevalence of CHE increases and prognosis worsens with age. Some studies demonstrate that age markedly influences all follow-up events, including total mortality, and mortality or hospitalisation related to CHE. Some studies suggest that physiological changes occur in CHE with ageing with an age-related increase in systemic vascular resistance and circulating noradrenaline (norepinephrine) concentrations and a decrease in renal function. 

Chueh SC, Kahan BD. Dyslipidemia in renal transplant recipients treated with a sirolimus and cyclosporine-based immunosuppressive regimen incidence, risk factors, progression, and prognosis. Transplantation 2003 76 375-82. 

In recent RT-PCR studies, many kallikreins have been proposed as new biomarkers for malignancies other than prostate cancer. Breast, ovarian, and testicular cancers are the most studied. Certain kallikreins were found to be differentially expressed in various malignancies (up- or downregulated), and the increase or decrease of their expression may be associated with prognosis [43, 58, 70, 89-94]. We have immunohistochemically evaluated some kallikreins in malignant diseases, including two series of prostate and renal cell carcinoma, and have examined their prognostic values [84, 85]. 

The prognosis of SLE has much improved during recent decades. The overall 10-year survival rate in retrospective series is 75-85% (Ul). The major cause of early death is usually active disease, whereas the leading cause of late death is atherosclerosis (A2). Infection is a major cause of mortality in all stages of SLE (G16). In our experience with SLE in children, the 5-year renal and patient survival rates were 93.1% and 91.08%, respectively (Y4). Several features of SLE have been associated with mortality in a multivariate model (A3). These features include renal damage, thrombocytopenia, very active disease at presentation, and lung involvement. Despite the large decrease in the mortality of SLE patients, there are still many issues to be resolved (G16). 

Nephrotic syndrome is a clinical and laboratory syndrome caused by the increased permeability of the glomerular capillary wall for macromolecules. Nephrotic syndrome is a potentially life-threatening state and persistent nephrotic syndrome has a poor prognosis with a high risk of progression to end-stage renal failure and a high risk of cardiovascular complications due to severe hyperlipidemia. 

There is good evidence that hypercalcemia continued over a long period can cause severe and often permanent damage, especially cerebral, skeletal, and renal. In the later stages of severe cases an irreversible azotemia, possibly with hypertension and with secondary renal dwarfism, may dominate the clinical picture. Thus prognosis is materially influenced by early diagnosis and the early institution of adequate treatment. 

The randomized controlled clinical trials performed by Freis and his colleagues at the Veterans Administration Hospitals have provided some of the first solid evidence that moderate permanent hypertension has an improved prognosis when actively treated by sodium depletion (hydrochlorothiazide), by interruption of the sympathetic nervous system (reserpine) and with a vasodilator (hydralazine) (262). In parallel, the beneficial effects of this triple therapy were demonstrated in spontaneously hypertensive rats by the spectacular prevention and cure of their cardiac, vascular, and renal lesions (263). 

This disorder shows a good prognosis, involving spontaneous recovery in most patients [4]. However, 29 (21.0%) of 138 patients required dialysis therapy owing to severe acute renal failure. No patient died in our series or in the literature consulted. 

Many patients have non-oliguric acute renal failure, with a good prognosis. However, some patients require dialysis. For treatment, hydration must be controlled, and nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided if possible. When oliguria is observed, dialysis therapy should be performed, as described for acute tubular necrosis. 

AN Bokhoven, A., Debryune, F. M., ScHALKEN, J. A. (1998). Expression of cadherin-6 as a novel diagnostic tool to predict prognosis of patients with E-cadherin-absent renal cell carcinoma. Clin. Cancer Res. 4, 2419-2424. 

Monitor electrolytes and renal function tests in symptomatic patients. Administer intravenous fluids to maintain urine output and to protect the kidneys from myoglobinuria. The prognosis is good if animals do not develop rhabdomyolysis or secondary infection. No chronic problems are expected from BZ itself (Holstege, 2006). 

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