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Wesson D.E.,Texas A&M University | Wesson D.E.,Scott and White Healthcare | Jo C.-H.,Scott and White Healthcare | Simoni J.,Texas Tech University Health Sciences Center
Kidney International | Year: 2012

Patients with a moderately reduced glomerular filtration rate (GFR) typically have no metabolic acidosis and a urine net acid excretion comparable to those with normal GFR, supporting greater per nephron acidification with moderately reduced GFR. We modeled such patients using rats with a surgical reduction of 2/3 kidney mass, yielding animals with reduced GFR without metabolic acidosis. We then tested the hypothesis that reduction of nephron mass augments distal nephron acidification in remnant nephrons mediated by increased angiotensin II activity, and that the latter is induced by underlying acid retention. Nephron mass reduction yielded lower GFR than controls (sham operation), higher acid retention (measured by microdialysis of kidney cortex), higher distal nephron acidification, and higher plasma and kidney levels of angiotensin II, but plasma total CO 2 and urine net acid excretion were not different. Angiotensin II receptor antagonism reduced distal nephron acidification to levels similar to control. Dietary alkali that lowered acid retention to that of control also reduced plasma and kidney levels of angiotensin II and reduced distal nephron acidification to control. Angiotensin II receptor antagonism with dietary alkali had no significant added effect on distal nephron acidification. Thus, nephron reduction that moderately reduced GFR with no metabolic acidosis is characterized by increased angiotensin II activity. This mediates increased distal nephron acidification and is induced by acid retention. © 2012 International Society of Nephrology.


Goraya N.,Texas A&M University | Goraya N.,Scott and White Healthcare | Simoni J.,Scott and White Healthcare | Jo C.-H.,Texas A&M University | And 3 more authors.
Clinical Journal of the American Society of Nephrology | Year: 2013

Background and objectives Current guidelines recommend Na+-based alkali for CKD with metabolic acidosis and plasma total CO2 (PTCO2) < 22 mM. Because diets in industrialized societies are typically acid-producing, we compared base-producing fruits and vegetables with oral NaHCO3 (HCO3) regarding the primary outcome of follow-up estimated GFR (eGFR) and secondary outcomes of improved metabolic acidosis and reduced urine indices of kidney injury. Design, setting, participants, & measurements Individuals with stage 4 (eGFR, 15-29 ml/min per 1.73 m2) CKD due to hypertensive nephropathy, had a PTCO2 level < 22 mM, and were receiving angiotensin-converting enzyme inhibition were randomly assigned to 1 year of daily oral NaHCO3 at 1.0 mEq/kg per day (n=35) or fruits and vegetables dosed to reduce dietary acid by half (n=36). Results Plasma cystatin C-calculated eGFR did not differ at baseline and 1 year between groups. One-year PTCO2 was higher than baseline in the HCO3 group (21.2±1.3 versus 19.5±1.5 mM; P<0.01) and the fruits and vegetables group (19.9±1.7 versus 19.3±1.9 mM; P<0.01), consistent with improved metabolic acidosis, and was higher in the HCO3 than the fruits and vegetable group (P<0.001). One-year urine indices of kidney injury were lower than baseline in both groups. Plasma [K+] did not increase in either group. Conclusions One year of fruits and vegetables or NaHCO3 in individuals with stage 4 CKD yielded eGFR that was not different, was associated with higher-than-baseline PTCO2, and was associated with lower-than-baseline urine indices of kidney injury. The data indicate that fruits and vegetables improve metabolic acidosis and reduce kidney injury in stage 4 CKD without producing hyperkalemia. Copyright © 2013 by the American Society of Nephro.


Loniewski I.,Sanum Polska Sp. Z O.o. Ul | Wesson D.E.,Scott and White Healthcare | Wesson D.E.,Texas A&M University
Kidney International | Year: 2014

Kidney injury in chronic kidney disease (CKD) is likely multifactorial, but recent data support that a component is mediated by mechanisms used by the kidney to increase acidification in response to an acid challenge to systemic acid-base status. If so, systemic alkalization might attenuate this acid-induced component of kidney injury. An acid challenge to systemic acid-base status increases nephron acidification through increased production of endothelin, aldosterone, and angiotensin II, each of which can contribute to kidney inflammation and fibrosis that characterizes CKD. Systemic alkalization that ameliorates an acid challenge might attenuate the contributions of angiotensin II, endothelin, and aldosterone to kidney injury. Some small clinical studies support the efficacy of alkalization in attenuating kidney injury and slowing glomerular filtration rate decline in CKD. This review focuses on the potential that orally administered NaHCO 3 prevents CKD progression and additionally addresses its mechanism of action, side effects, possible complications, dosage, interaction, galenic form description, and contraindications. Current National Kidney Foundation guidelines recommend oral alkali, including NaHCO 3 -, in CKD patients with serum HCO 3 - <22 mmol/l. Although oral alkali can be provided by other medications and by base-inducing dietary constituents, oral NaHCO 3 will be the focus of this review because of its relative safety and apparent efficacy, and its comparatively low cost. © 2013 International Society of Nephrology.


Goraya N.,Texas A&M University | Simoni J.,Texas Tech University Health Sciences Center | Jo C.-H.,Scott and White Healthcare | Wesson D.E.,Texas A&M University
Kidney International | Year: 2014

Alkali therapy of metabolic acidosis in patients with chronic kidney disease (CKD) with plasma total CO2 (TCO2) below 22 mmol/l per KDOQI guidelines appears to preserve estimated glomerular filtration rate (eGFR). Since angiotensin II mediates GFR decline in partial nephrectomy models of CKD and even mild metabolic acidosis increases kidney angiotensin II in animals, alkali treatment of CKD-related metabolic acidosis in patients with plasma TCO2 over 22 mmol/l might preserve GFR through reduced kidney angiotensin II. To test this, we randomized 108 patients with stage 3 CKD and plasma TCO2 22-24 mmol/l to Usual Care or interventions designed to reduce dietary acid by 50% using sodium bicarbonate or base-producing fruits and vegetables. All were treated to achieve a systolic blood pressure below 130 mm Hg with regimens including angiotensin converting enzyme inhibition and followed for 3 years. Plasma TCO2 decreased in Usual Care but increased with bicarbonate or fruits and vegetables. By contrast, urine excretion of angiotensinogen, an index of kidney angiotensin II, increased in Usual Care but decreased with bicarbonate or fruits and vegetables. Creatinine-calculated and cystatin C-calculated eGFR decreased in all groups, but loss was less at 3 years with bicarbonate or fruits and vegetables than Usual Care. Thus, dietary alkali treatment of metabolic acidosis in CKD that is less severe than that for which KDOQI recommends therapy reduces kidney angiotensin II activity and preserves eGFR. © 2014 International Society of Nephrology.


Goraya N.,Texas A&M University | Simoni J.,Texas Tech University Health Sciences Center | Jo C.,Scott and White Healthcare | Wesson D.E.,Texas A&M University | Wesson D.E.,Scott and White Healthcare
Kidney International | Year: 2012

The neutralization of dietary acid with sodium bicarbonate decreases kidney injury and slows the decline of the glomerular filtration rate (GFR) in animals and patients with chronic kidney disease. The sodium intake, however, could be problematic in patients with reduced GFR. As alkali-induced dietary protein decreased kidney injury in animals, we compared the efficacy of alkali-inducing fruits and vegetables with oral sodium bicarbonate to diminish kidney injury in patients with hypertensive nephropathy at stage 1 or 2 estimated GFR. All patients were evaluated 30 days after no intervention; daily oral sodium bicarbonate; or fruits and vegetables in amounts calculated to reduce dietary acid by half. All patients had 6 months of antihypertensive control by angiotensin-converting enzyme inhibition before and during these studies, and otherwise ate ad lib. Indices of kidney injury were not changed in the stage 1 group. By contrast, each treatment of stage 2 patients decreased urinary albumin, N-acetyl Β-D-glucosaminidase, and transforming growth factor Β from the controls to a similar extent. Thus, a reduction in dietary acid decreased kidney injury in patients with moderately reduced eGFR due to hypertensive nephropathy and that with fruits and vegetables was comparable to sodium bicarbonate. Fruits and vegetables appear to be an effective kidney protective adjunct to blood pressure reduction and angiotensin-converting enzyme inhibition in hypertensive and possibly other nephropathies.


Monticciolo D.L.,Texas A&M University | Monticciolo D.L.,Scott and White Healthcare
American Journal of Roentgenology | Year: 2012

OBJECTIVE. The purpose of this article is to outline a quick and effective method of confirming MR-sonographic correlation for lesions detected with MRI but percutaneously biopsied using ultrasound. CONCLUSION. Ensuring that a lesion seen on targeted ultrasound is the same as that detected at MRI can be difficult. For benign concordant lesions, a mismatch may only be discovered at 6-month postbiopsy MRI follow-up. However, lesion correlation can be established on the same day as biopsy by obtaining a single unenhanced T1-weighted non-fat-saturated pulse sequence just after percutaneous ultrasound-guided biopsy. Scanning time is less than 4 minutes. Postbiopsy changes and the biopsy clip are easily seen and help verify MR-sonographic lesion correlation. © American Roentgen Ray Society.


Collins J.B.,Scott and White Healthcare | Verheyden C.N.,Scott and White Healthcare
Plastic and Reconstructive Surgery | Year: 2012

BACKGROUND: Prosthetic breast implants are frequently used by plastic surgeons for reconstructive and aesthetic procedures. One known complication of the procedure is postoperative breast hematoma. However, the incidence and risk factors of this problem are not fully characterized. METHODS: A retrospective analysis was performed of a prospectively collected patient medical record database based on procedure codes to identify breast hematomas and possible risk factors over a 12-year period from November of 1996 to October of 2008. RESULTS: One thousand nine hundred thirty-six operations were performed on 3474 breasts with prosthetic implants used. Average patient follow-up was 48.9 months, with 32 hematomas identified following 32 operations. The latest hematoma identified was 21 months after the procedure. Hematomas were identified on average 37 days after the operation. CONCLUSIONS: In the authors' experience, postoperative breast hematomas after prosthetic implant placement occur in 0.92 percent of breast prostheses placed. No individual surgical approach is associated with the occurrence of breast hematomas. Hematomas are not statistically associated with any measured patient or surgically defined characteristic. Specifically, no statistical significance was shown for larger implant size, reoperation, operative indication, type of surgery, or implant type as an independent risk factor. Copyright © 2012 by the American Society of Plastic Surgeons.


Parker W.L.,Scott and White Healthcare
Plastic and Reconstructive Surgery | Year: 2013

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Recount the epidemiology of basilar joint arthritis. 2. Understand how the anatomy and kinematics of this joint contribute to the development of the disease process. 3. Combine patient history, clinical examination, and radiographic findings to formulate a diagnosis and staging of the arthritis. 4. Incorporate conservative management into the patient treatment plan to aid in determining a patient's surgical candidacy. 5. Comprehend the basic principles of available surgical options, potential complications, and evidence pertaining to surgical outcome. SUMMARY: This article has been prepared to accompany practice-based assessment with ongoing surgical education for the Maintenance of Certification for the American Board of Plastic Surgery. It is structured for physicians to comparatively evaluate their care of a patient with arthritis of the thumb carpometacarpal joint. Copyright © 2013 by the American Society of Plastic Surgeons.


Piziak V.,Scott and White Healthcare
Southern Medical Journal | Year: 2010

Objective: The problem of high body mass index (BMI) for age in the Head Start population in Texas is of great concern. The primarily Mexican American population is at high risk for diabetes and cardiovascular disease. This study examines the prevalence of elevated BMI for age in the Head Start population in a sampling of South Texas border counties and a Central Texas county from 2003-2008, and compares it to the Centers for Disease Control and Prevention (CDC) and National Health and Nutrition Examination Survey (NHANES) data for Hispanic preschool children. Methods: 18,462 age/gender-adjusted BMI measurements obtained by Texas Head Start centers for 2-5 year old children were analyzed to determine the prevalence of BMI for age at the 97th, 95th, and 85th percentiles. Results: In the overall Texas population, 40.79% of males and 36.73% of females were overweight (85th percentile and above) and 20.01% of the males and 19.04% of the females were obese (95th percentile and above). The prevalence of high BMI for age was stable between 2003-2008; however, the overweight cohort increased with the age of the children over that period of time. Conclusion: The observed prevalence of elevated BMI in the Texas population is significantly higher than the results for the 2000 age-adjusted gender specific CDC growth charts for Mexican-American children ages 2-5 years old in the NHANES data for 2003-2006. The Texas-Mexico border counties had the highest prevalence of elevated BMI, demonstrating a critical need for dietary and exercise interventions in this medically underserved area. © 2010 by The Southern Medical Association.


Basu R.,Scott and White HealthCare
Research on Aging | Year: 2013

This study examined importance of education on dementia risk among older adults. It explored to what extent this relationship represents an independent effect of education on dementia risk. A cross-sectional sample of adults age 70 years or older was selected from the Aging Demographics and Memory Study, a supplement to the Health and Retirement Study, to examine the association between education and dementia risk and to mitigate the possibility of self-selection bias (unobserved variable bias) in explaining this correlation. An identification strategy using parental and sibling characteristics as instrumental variables for education was used to remove bias from the estimate of education parameter's effect on dementia risk. The association between education and dementia risk was observed after accounting for self-selection bias. Results from the two-stage ordered logit model suggest that the impact of education on dementia risk is not an artifact but rather the observed association between education and dementia incidence has a causal component. © The Author(s) 2013.

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