LOS ANGELES, CA – January 19, 2008 – During the last decade, the prevalence of obesity in industrialized countries has increased dramatically. Currently approximately 25% of adults in the USA are obese and 40-45 % are overweight. Obese and overweight individuals often have hypertension and manifest a clustering of metabolic and hormonal abnormalities, including insulin resistance, hyperinsulinemia, hypertriglyceridemia, low HDL cholesterol that increase the risk of cardiovascular diseases and events, as well the risk for chronic kidney disease. The epidemic of obesity is in large part determining an epidemic of diabetes, and diabetes currently represents the most common cause of chronic kidney disease and end-stage renal disease in this country.
To address these issues, the Division of Nephrology at Keck School of Medicine, University of Southern California, on January 19, 2008 held a Symposium entitled “IS THERE AN EPIDEMIC OF CHRONIC KIDNEY DISEASE (CKD) IN THE US? CAUSES, CARDIOVASCULAR CONSEQUENCES, AND MANAGEMENT”. This symposium was largely supported by a grant provided by a non-profit entity, UKDRA**, whose mission is to establish and support a premiere kidney research institute in conjunction with the Keck School at USC. This symposium gathered a multitude of experts from the United States and France and provided the audience with state-of-the art information pertaining to the subject. The symposium consisted of three sessions.
In the first session, Alan S. L. Yu, M.D., an Associate Professor of Medicine and Physiology of the Keck School of Medicine at USC, reviewed the epidemiologic evidence for the epidemic of chronic kidney disease in the U.S. and the currently available tools to best diagnose this ailment. Daniel E. Weiner, M.D. an Assistant Professor of Medicine from Tufts University School of Medicine in Boston, MA reviewed the bi-directional relationship between CKD and cardiovascular disease. He emphasized the known fact that the presence of CKD increased the risk of death from myocardial infarction and stroke. Conversely, the presence of cardiovascular diseases may hamper kidney function. Sharon Adler, M.D., a Professor of Medicine and Chief, Division of Nephrology at Harbor/UCLA in Los Angeles, had the critical task of discussing the importance of diabetes as a cause of CKD and provided both experimental as well as kidney evidence explaining how diabetes mellitus can lead to kidney injury. More importantly, Dr. Adler reviewed current effective methods to retard or even arrest the progression of kidney disease in diabetic patients. Stephen C. Textor, M.D., Professor of Medicine and Vice-Chair, Division of Nephrology and Hypertension at Mayo Clinic in Rochester, MN, discussed the important and difficult task of how to diagnose and manage CKD caused by partial or total occlusion of the renal arteries.
The second session dealt with “Advances in the Pathophysiology of CKD”. This was the most exciting and novel part of the symposium, since it dealt with some of the current discoveries and promises in the field of CKD. Genevieve Nguyen, M.D., Ph.D., Director of Research Institute National de la Sante’ et de la Recherche Medicale (INSERM), College de France in Paris, discussed her recent discovery of prorenin and its receptor and the implication of this receptor to kidney and cardiovascular disease. Prorenin is a precursor of renin, a well-known enzyme that converts angiotensinogen into angiotensin I and subsequently into angiotensin II, a hormone that can contribute to raising blood pressure and kidney damage in patients with CKD. For a long time it was established that the formation or action of angiotensin II could be blocked by ACE-inhibitors and sartans, drugs commonly used for the treatment of hypertension and to reduce progression of kidney disease and mortality in patients with heart failure. Dr. Nguyen provided evidence that these drugs may not completely block the renin-angiotensin-aldosterone system and binding of renin and prorenin to the renin receptor may mediate kidney injury even when patients are taking ACE-inhibitors and sartans. This discovery is very relevant since it may lead to the development of antagonists of the renin receptors, and those might lead to further kidney and cardiovascular protection.
Nick D. Vaziri, M.D., Professor of Medicine, Physiology and Biophysics, and Chief, Division of Nephrology and Hypertension, Schools of Medicine and Biological Sciences of the University of California at Irvine discussed the interplay of oxidative stress, inflammation and the renin angiotensin system (RAS) in progression of CKD. The importance of these studies is that anti-oxidants in conjunction with RAS inhibitors might reduce progression of kidney disease.
Vito M. Campese, M.D., the Symposium Director, Professor of Medicine, Physiology and Biophysics, and Chief, Division of Nephrology and Hypertension at Keck School of Medicine, discussed the impact of high cholesterol on kidney disease and the utility of statins in CKD progression.
Elaine Reed, Ph.D., Director, UCLA Immunogenetics Center, Professor of Pathology and Laboratory Medicine at the Geffen School of Medicine at UCLA, discussed novel diagnostic tools to identify patients who have received organ transplantation and who are at risk of rejecting their organs. Identifying these patients earlier will lead to prevention of rejection, early treatment, and better organ preservation.
During lunch, Emil Paganini, M.D., Section Head, Dialysis and Extracorporeal Therapy, Glyckman Urological and Kidney institute at the Cleveland Clinic in Cleveland, OH, discussed medicare reimbursement issues involving the kidney patient.
The third session dealt with new and old therapeutic strategies in patients with CKD. Richard J. Glassock, M.D., Emeritus Professor, Geffen School of Medicine, UCLA, discussed “IgA nephropathy, the most common form of glomerulonephritis in the world”.
Robert D. Toto, the Mary M. Conroy Professor in Kidney Disease at the University of Texas Southwestern Medical Center in Dallas, TX addressed the issue of “How to optimize the use of RAS inhibitors in CKD”.
Jeffrey S. Berns, M.D., Professor of Medicine and Pediatrics and Acting Chief, Renal-Electrolyte and Hypertension Division, at the University of Pennsylvania School of Medicine in Philadelphia, PA discussed the issue of how to treat anemia in patients with CKD. This subject is relevant in view of recent studies suggesting that the inappropriate use of erythropoietin may increase rather than reduce cardiovascular events.
Lastly, Kumar Sharma, M.D., Professor of Medicine, Director of Translational Research in Kidney Disease at the University of San Diego, San Diego, CA, looked at the future and discussed “New therapeutic strategies to arrest the progression of kidney disease”. Dr. Sharma reviewed all on-going trials with unapproved medications that are likely to become available in the near future for management of CKD.
The symposium was attended by more than 180 participants, nephrologists, cardiologists, internists, general practitioners and nurses.
** Note: UKRO was UKDRA (University Kidney Disease Research Associates) prior to November 2008.