In this article we deal with three aspects of acidosis in patients with chronic renal insufficien... more In this article we deal with three aspects of acidosis in patients with chronic renal insufficiency: clinical characteristics, patho-physiology, and therapeutic approach.
American journal of kidney diseases : the official journal of the National Kidney Foundation, 1994
Renal stone formation is uncommon in patients with type IV renal tubular acidosis (RTA). This stu... more Renal stone formation is uncommon in patients with type IV renal tubular acidosis (RTA). This study was undertaken to explore the urinary biochemical and physicochemical factors in patients with type IV RTA in order to elucidate the mechanisms that protect them from renal stone formation. Twelve subjects with type IV RTA and 12 matched subjects with a similar degree of kidney impairment but without RTA were studied. Both groups of patients had low urinary excretion of calcium, phosphorus, uric acid, and citrate, probably reflective of kidney impairment. Patients with type IV RTA had a significantly lower urinary pH and urinary excretion of calcium than their matched controls. Hypocitraturia was present in both groups without any significant difference between them. This study suggests that the major protection from renal stone formation in type IV RTA results from impaired renal function and ensuing reduction in renal excretion of stone-forming substances, such as calcium and uric a...
The purpose of the present investigation was to determine whether dexamethasone, an agent known t... more The purpose of the present investigation was to determine whether dexamethasone, an agent known to preserve the blood-brain barrier, and colchicine, an agent that impairs mobilization of macrophages, can prevent demyelinating lesions associated with rapid correction of hyponatremia in the experimental animal. Hyponatremia was induced in rats with Pitressin and water. After 4 days hyponatremic rats received hypertonic saline alone or hypertonic saline plus dexamethasone or colchicine. All of the 9 rats that received only 5% NaCl developed demyelinating disease, while 3 of 6 rats treated with dexamethasone and 5 of 15 rats treated with colchicine showed no CNS abnormality. The results of our investigation might help understand the pathogenetic mechanism of central pontine myelinolysis in humans, a disease attributed to rapid correction of hyponatremia.
Protein catabolic rate (PCR) or its normalized value, nPCR, is widely used to define nutritional ... more Protein catabolic rate (PCR) or its normalized value, nPCR, is widely used to define nutritional status in dialysis patients [1]. This term PCR obviously is a misnomer and refers to the net PCR since the total PCR is as high as 300 g/day and does not necessarily bear a relationship with protein intake [2]. In the steady state, the net PCR has to be equal to the dietary protein intake as long as the method to calculate PCR includes all the body nitrogen output.
Data from experimental animals suggest that probiotic supplements may retard CKD progression. How... more Data from experimental animals suggest that probiotic supplements may retard CKD progression. However, the relationship between probiotic use, frequent yogurt consumption (as a natural probiotic source), and kidney parameters have not been evaluated in humans. We utilized NHANES data, and analyzed the association of probiotic alone (1999-2012) and yogurt/probiotic (2003-2006) use with albuminuria and eGFR after adjustment for demographic and clinical parameters. Frequent yogurt consumption was defined as thrice or more weekly over the year prior to the interview. Frequent yogurt/probiotic consumers had lower adjusted odds of developing combined outcome (albuminuria and/or eGFR < 60 ml/min/1.73 m(2)) compared to infrequent consumers (OR = 0.76; 95 % CI = 0.61-0.94). When evaluated separately, frequent consumers had lower odds of albuminuria and nonsignificant trend towards decreased odds of low eGFR compared to infrequent consumers. In the probiotic cohort, probiotic consumers wer...
There is growing evidence of the involvement of advanced glycation end products (AGEs) in the pat... more There is growing evidence of the involvement of advanced glycation end products (AGEs) in the pathogenesis of neurodegenerative processes including Alzheimer's disease (AD) and their function as a seed for the aggregation of Aβ, a hallmark feature of AD. AGEs are formed endogenously and exogenously during heating and irradiation of foods. We here examined the effect of a diet high in AGEs in the context of an irradiated diet on memory, insoluble Aβ42 , AGEs levels in hippocampus, on expression of the receptor for AGEs (RAGE), and on oxidative stress in the vasculature. We found that AD-like model mice on high-AGE diet due to irradiation had significantly poorer memory, higher hippocampal levels of insoluble Aβ42 and AGEs as well as higher levels of oxidative stress on vascular walls, compared to littermates fed an isocaloric diet. These differences were not due to weight gain. The data were further supported by the overexpression of RAGE, which binds to Aβ42 and regulates its tr...
In the last few years, peritoneal dialysis (PD) catheter placement techniques and outcomes have b... more In the last few years, peritoneal dialysis (PD) catheter placement techniques and outcomes have become important because of the growing population of PD patients. Although there are a growing number of catheters placed by the minimally invasive Y-TEC peritoneoscopic technique, there are still limited data on outcomes for these catheters, especially those placed by a surgeon. We aimed to conduct a retrospective study of our experience with PD catheters placed by the Y-TEC peritoneoscopic technique in our institution. We reviewed patients with peritoneoscopic PD catheter insertion over the last decade and described their complications and outcomes. In a secondary analysis, we compared the outcomes and complications of these catheters with those with open placement placed by the same surgeon. We had complete data on 62 patients with peritoneoscopic catheter placement during the study period. The mean age was 55 years, 48.4% were females and the most common cause of end-stage renal disease was diabetes mellitus (33%). Surgical complications were seen in only 6/62 (9.6%) and peritonitis in 16/62 (26%) of peritoneoscopic catheters. Most catheters were used after 2 months of placement, while 12.3% were used within 2 months. When compared with 93 patients with open placement of catheters as a secondary analysis, peritoneoscopic catheters were found to have a higher 2-year survival. Our large series of peritoneoscopically placed catheters by a surgeon demonstrate low surgical complications and peritonitis rates as well as superior 2-year survival compared with open placement of catheters.
s u m m a r y Background and aims: Epidemiological studies have shown an association between cons... more s u m m a r y Background and aims: Epidemiological studies have shown an association between consumption of white rice and prevalence of insulin resistance. We wanted to test the effect of substituting brown rice for white rice on insulin resistance. Methods: A group of Chinese American (n ¼ 100) with screening pre-diabetes in the area of Flushing, New York City, were randomized to either continue their usual white rice intake (n ¼ 51) or change to brown rice (n ¼ 49) for 3 months. Fasting blood was obtained at baseline and end of study in both groups for measurement of circulating and cellular (peripheral mononuclear cells) metabolic and inflammatory markers. Results: Only 58 subjects (white rice ¼ 28 and brown rice ¼ 30) finished the study. Their analysis shows significant weight loss and fall of systolic and diastolic blood pressure only in those ingesting brown rice. Insulin and HOMA, serum AGEs and 8-isoprostane decreased, while SIRT1 mRNA increased in the brown rice group as compared to the white rice group. Conclusions: Substituting brown rice for white rice in a pre-diabetes population with high daily consumption of rice has a very beneficial effect in improving their metabolic risk factors. Further studies are needed to confirm these findings.
Over the past 2 decades there has been increasing evidence supporting an important contribution f... more Over the past 2 decades there has been increasing evidence supporting an important contribution from food-derived advanced glycation end products (AGEs) to the body pool of AGEs and therefore increased oxidative stress and inflammation, processes that play a major role in the causation of chronic diseases. A 3-d symposium (1st Latin American Symposium of AGEs) to discuss this subject took place in Guanajuato, Mexico, on 1-3 October 2014 with the participation of researchers from several countries. This review is a summary of the different presentations and subjects discussed, and it is divided into 4 sections. The first section deals with current general knowledge about AGEs. The second section dwells on mechanisms of action of AGEs, with special emphasis on the receptor for advanced glycation end products and the potential role of AGEs in neurodegenerative diseases. The third section discusses different approaches to decrease the AGE burden. The last section discusses current metho...
Increasing evidence in the literature suggests an important role for advanced glycation end produ... more Increasing evidence in the literature suggests an important role for advanced glycation end products (AGEs) in the generation of a state of increased oxidative stress and chronic subclinical inflammation, which underlies most modern chronic diseases, including diabetes, cardiovascular disease and chronic kidney disease (CKD). Although AGEs were originally thought to form only endogenously, primarily as the result of the hyperglycemia of diabetes, it is now clear that exogenous AGEs, specially incorporated in foods, are an important contributor to the body pool of AGEs. Over the past decade, several clinical trials have been performed in a variety of conditions demonstrating that the application of an AGE-restricted diet reduces not only the systemic levels of AGEs but also the levels of markers of oxidative stress and inflammation. This has been shown in CKD patients before and after the initiation of dialysis and either in the presence or absence of coexistent diabetes. Reduction o...
In this article we deal with three aspects of acidosis in patients with chronic renal insufficien... more In this article we deal with three aspects of acidosis in patients with chronic renal insufficiency: clinical characteristics, patho-physiology, and therapeutic approach.
American journal of kidney diseases : the official journal of the National Kidney Foundation, 1994
Renal stone formation is uncommon in patients with type IV renal tubular acidosis (RTA). This stu... more Renal stone formation is uncommon in patients with type IV renal tubular acidosis (RTA). This study was undertaken to explore the urinary biochemical and physicochemical factors in patients with type IV RTA in order to elucidate the mechanisms that protect them from renal stone formation. Twelve subjects with type IV RTA and 12 matched subjects with a similar degree of kidney impairment but without RTA were studied. Both groups of patients had low urinary excretion of calcium, phosphorus, uric acid, and citrate, probably reflective of kidney impairment. Patients with type IV RTA had a significantly lower urinary pH and urinary excretion of calcium than their matched controls. Hypocitraturia was present in both groups without any significant difference between them. This study suggests that the major protection from renal stone formation in type IV RTA results from impaired renal function and ensuing reduction in renal excretion of stone-forming substances, such as calcium and uric a...
The purpose of the present investigation was to determine whether dexamethasone, an agent known t... more The purpose of the present investigation was to determine whether dexamethasone, an agent known to preserve the blood-brain barrier, and colchicine, an agent that impairs mobilization of macrophages, can prevent demyelinating lesions associated with rapid correction of hyponatremia in the experimental animal. Hyponatremia was induced in rats with Pitressin and water. After 4 days hyponatremic rats received hypertonic saline alone or hypertonic saline plus dexamethasone or colchicine. All of the 9 rats that received only 5% NaCl developed demyelinating disease, while 3 of 6 rats treated with dexamethasone and 5 of 15 rats treated with colchicine showed no CNS abnormality. The results of our investigation might help understand the pathogenetic mechanism of central pontine myelinolysis in humans, a disease attributed to rapid correction of hyponatremia.
Protein catabolic rate (PCR) or its normalized value, nPCR, is widely used to define nutritional ... more Protein catabolic rate (PCR) or its normalized value, nPCR, is widely used to define nutritional status in dialysis patients [1]. This term PCR obviously is a misnomer and refers to the net PCR since the total PCR is as high as 300 g/day and does not necessarily bear a relationship with protein intake [2]. In the steady state, the net PCR has to be equal to the dietary protein intake as long as the method to calculate PCR includes all the body nitrogen output.
Data from experimental animals suggest that probiotic supplements may retard CKD progression. How... more Data from experimental animals suggest that probiotic supplements may retard CKD progression. However, the relationship between probiotic use, frequent yogurt consumption (as a natural probiotic source), and kidney parameters have not been evaluated in humans. We utilized NHANES data, and analyzed the association of probiotic alone (1999-2012) and yogurt/probiotic (2003-2006) use with albuminuria and eGFR after adjustment for demographic and clinical parameters. Frequent yogurt consumption was defined as thrice or more weekly over the year prior to the interview. Frequent yogurt/probiotic consumers had lower adjusted odds of developing combined outcome (albuminuria and/or eGFR < 60 ml/min/1.73 m(2)) compared to infrequent consumers (OR = 0.76; 95 % CI = 0.61-0.94). When evaluated separately, frequent consumers had lower odds of albuminuria and nonsignificant trend towards decreased odds of low eGFR compared to infrequent consumers. In the probiotic cohort, probiotic consumers wer...
There is growing evidence of the involvement of advanced glycation end products (AGEs) in the pat... more There is growing evidence of the involvement of advanced glycation end products (AGEs) in the pathogenesis of neurodegenerative processes including Alzheimer's disease (AD) and their function as a seed for the aggregation of Aβ, a hallmark feature of AD. AGEs are formed endogenously and exogenously during heating and irradiation of foods. We here examined the effect of a diet high in AGEs in the context of an irradiated diet on memory, insoluble Aβ42 , AGEs levels in hippocampus, on expression of the receptor for AGEs (RAGE), and on oxidative stress in the vasculature. We found that AD-like model mice on high-AGE diet due to irradiation had significantly poorer memory, higher hippocampal levels of insoluble Aβ42 and AGEs as well as higher levels of oxidative stress on vascular walls, compared to littermates fed an isocaloric diet. These differences were not due to weight gain. The data were further supported by the overexpression of RAGE, which binds to Aβ42 and regulates its tr...
In the last few years, peritoneal dialysis (PD) catheter placement techniques and outcomes have b... more In the last few years, peritoneal dialysis (PD) catheter placement techniques and outcomes have become important because of the growing population of PD patients. Although there are a growing number of catheters placed by the minimally invasive Y-TEC peritoneoscopic technique, there are still limited data on outcomes for these catheters, especially those placed by a surgeon. We aimed to conduct a retrospective study of our experience with PD catheters placed by the Y-TEC peritoneoscopic technique in our institution. We reviewed patients with peritoneoscopic PD catheter insertion over the last decade and described their complications and outcomes. In a secondary analysis, we compared the outcomes and complications of these catheters with those with open placement placed by the same surgeon. We had complete data on 62 patients with peritoneoscopic catheter placement during the study period. The mean age was 55 years, 48.4% were females and the most common cause of end-stage renal disease was diabetes mellitus (33%). Surgical complications were seen in only 6/62 (9.6%) and peritonitis in 16/62 (26%) of peritoneoscopic catheters. Most catheters were used after 2 months of placement, while 12.3% were used within 2 months. When compared with 93 patients with open placement of catheters as a secondary analysis, peritoneoscopic catheters were found to have a higher 2-year survival. Our large series of peritoneoscopically placed catheters by a surgeon demonstrate low surgical complications and peritonitis rates as well as superior 2-year survival compared with open placement of catheters.
s u m m a r y Background and aims: Epidemiological studies have shown an association between cons... more s u m m a r y Background and aims: Epidemiological studies have shown an association between consumption of white rice and prevalence of insulin resistance. We wanted to test the effect of substituting brown rice for white rice on insulin resistance. Methods: A group of Chinese American (n ¼ 100) with screening pre-diabetes in the area of Flushing, New York City, were randomized to either continue their usual white rice intake (n ¼ 51) or change to brown rice (n ¼ 49) for 3 months. Fasting blood was obtained at baseline and end of study in both groups for measurement of circulating and cellular (peripheral mononuclear cells) metabolic and inflammatory markers. Results: Only 58 subjects (white rice ¼ 28 and brown rice ¼ 30) finished the study. Their analysis shows significant weight loss and fall of systolic and diastolic blood pressure only in those ingesting brown rice. Insulin and HOMA, serum AGEs and 8-isoprostane decreased, while SIRT1 mRNA increased in the brown rice group as compared to the white rice group. Conclusions: Substituting brown rice for white rice in a pre-diabetes population with high daily consumption of rice has a very beneficial effect in improving their metabolic risk factors. Further studies are needed to confirm these findings.
Over the past 2 decades there has been increasing evidence supporting an important contribution f... more Over the past 2 decades there has been increasing evidence supporting an important contribution from food-derived advanced glycation end products (AGEs) to the body pool of AGEs and therefore increased oxidative stress and inflammation, processes that play a major role in the causation of chronic diseases. A 3-d symposium (1st Latin American Symposium of AGEs) to discuss this subject took place in Guanajuato, Mexico, on 1-3 October 2014 with the participation of researchers from several countries. This review is a summary of the different presentations and subjects discussed, and it is divided into 4 sections. The first section deals with current general knowledge about AGEs. The second section dwells on mechanisms of action of AGEs, with special emphasis on the receptor for advanced glycation end products and the potential role of AGEs in neurodegenerative diseases. The third section discusses different approaches to decrease the AGE burden. The last section discusses current metho...
Increasing evidence in the literature suggests an important role for advanced glycation end produ... more Increasing evidence in the literature suggests an important role for advanced glycation end products (AGEs) in the generation of a state of increased oxidative stress and chronic subclinical inflammation, which underlies most modern chronic diseases, including diabetes, cardiovascular disease and chronic kidney disease (CKD). Although AGEs were originally thought to form only endogenously, primarily as the result of the hyperglycemia of diabetes, it is now clear that exogenous AGEs, specially incorporated in foods, are an important contributor to the body pool of AGEs. Over the past decade, several clinical trials have been performed in a variety of conditions demonstrating that the application of an AGE-restricted diet reduces not only the systemic levels of AGEs but also the levels of markers of oxidative stress and inflammation. This has been shown in CKD patients before and after the initiation of dialysis and either in the presence or absence of coexistent diabetes. Reduction o...
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Papers by Jaime Uribarri