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Entries in Kidneys (5)

Monday
Jun182012

Down a Kidney? Don’t Rule Out Sports

Thomas Northcut/Thinkstock(SALT LAKE CITY) -- If you’re born with only one kidney, you can forget about being a football star or a hockey hall-of-famer -- or at least, that’s been the conventional medical wisdom espoused for the last few decades.

But a new study found that missing a kidney shouldn’t necessarily keep kids from playing contact sports.

Researchers at the University of Utah combed data on high school athletes’ injuries reported to the National Athletic Trainers’ Association, including those playing collision-prone sports like football, field hockey and basketball.  Of the more than 23,000 injuries that players sustained from 1995 to 1997, just 18 were kidney injuries.  And even those injuries were fairly mild.  None of the players had catastrophic kidney injuries that required major medical care.

Injuries to knees, eyes and heads were much more common.  Among football players, there were 64 concussions for every one kidney injury.

Dr. Matthew Grinsell, the study’s lead author and an assistant professor of pediatrics at the University of Utah School of Medicine, said based on the numbers, a lot of other everyday activities are riskier for the kidneys than playing contact sports.

“It looks like bicycle riding and downhill skiing are more dangerous than football,” he said.  “And all sports are way down the list of risks compared with motor vehicle accidents.”

About one in 750 people are born without one of their kidneys, according to the National Kidney Foundation.  Others are born with a kidney that simply doesn’t work or needs to be removed because of a tumor or an abnormality in the urinary tract.

In the past, doctors have erred on the side of caution when it comes to people who have only one of an organ that usually comes in pairs, like kidneys or testicles. But Dr. Alex Diamond, an assistant professor of pediatrics and a team physician for Vanderbilt University, said doctors usually try to strike a balance between protecting vital organs and reaping the benefits of athletics when advising patients and their families.

“You don’t want to under restrict someone who could be dangerously injured, but you don’t want to over restrict someone from all the social, physical and psychological benefits of playing sports,” he said.

The American Academy of Pediatrics doesn’t say that all children who are down one kidney should be kept on the sidelines.  Instead, the group recommends giving these kids a “qualified yes” for sports participation after they are examined and cleared for play by a doctor.

Copyright 2012 ABC News Radio

Tuesday
Jun052012

Surgeon: Remove Kidneys for Transplant Before Donor's Death

Stockbyte/Thinkstock(NEW YORK) -- The severe shortage of viable organs for transplantation in the U.S. has led a transplant surgeon to propose harvesting kidneys from people who are not dead yet.

Dr. Paul Morrissey, an associate professor of surgery at Brown University's Alpert Medical School, wrote in The American Journal of Bioethics that the protocol known as donation after cardiac death -- meaning death as a result of irreversible damage to the cardiovascular system -- has increased the number of organs available for transplant, but has a number of limitations, including the need to wait until the heart stops.

Because of the waiting time, Morrissey said that about one-third of potential donors end up not being able to donate, and many organs turn out to not be viable as a result.

Instead, he argues in favor of procuring kidneys from patients with severe irreversible brain injury whose families consent to kidney removal before their cardiac and respiratory systems stop functioning.

"These individuals, maintained on mechanical ventilation, do not meet the criteria for brain death," he wrote. In these cases, the patient would be removed from life support and kidneys would be harvested while ensuring that the patient receives anesthesia and pain relief during the operation. After that, the patients would be kept comfortable until they have not had a pulse for five minutes, a threshold at which they are declared dead.

"Under this protocol, the donor is alive at the time of kidney recovery, but a determination has been made and confirmed by medical experts that death is imminent," he wrote.

Kidney removal, he stressed, would not cause the death of the donor, which is "instead caused foremost by the original catastrophic injury and secondarily by terminating mechanical ventilation."

In addition to providing more organs usable for transplant, Morrissey said this revised protocol would allow families to grieve in peace, since surgeons wouldn't need to rush the body into the operating room to remove organs. He said they could also take comfort in the knowledge that their loved one's death saved other lives.

A number of experts responded to Morrissey's proposal in commentaries published in the same journal. Some supported his arguments, while others expressed concern that it wouldn't be in the donor's best interests and could potentially violate medical ethics and the law.

Donald Marquis, a professor at the University of Kansas, wrote that Morrissey's argument has some validity.

Removing both kidneys, he said, "will not make the donor worse off than the donor would have been in the absence of the nephrectomy."

"Though not dead yet, they are 'as good as dead' from an ethical perspective," wrote Franklin Miller, a bioethicist at the National Institutes of Health, along with Dr. Robert Truog, a professor of medical ethics, anesthesiology and pediatrics at Harvard Medical School. "No harm or wrong is committed by procuring vital organs prior to stopping life support, provided that valid consent is obtained for donation."

But removing both kidneys from a living donor would not always be in a patient's best interests.

"There is no reason to believe that registering as an organ donor involves the willingness to undergo premortem double nephrectomy," argued bioethicists Maxwell Smith of the University of Toronto, David Rodriguez-Arias of the Spanish National Research Council and Ivan Ortega of Alcala de Henares University.

And Norman Cantor, a distinguished professor of law at Rutgers School of Law, wrote that removing both kidneys before death could be legally risky.

"An organ retrieval intervention poses some hazard of accelerating death, as by hemorrhage or cardiac arrest," he said. "Any medical action potentially accelerating death, even by a few minutes and even for a gravely debilitated patient, demands a legally recognized justification."

Removing one kidney, he said, could be legally defensible, but removing both "would almost certainly be deemed unlawful under the current legal framework."

Copyright 2012 ABC News Radio

Friday
Jun012012

High-Protein, Low-Carb Diet Safe for Kidneys

Creatas/Thinkstock(INDIANAPOLIS) -- For decades, medical experts have been concerned that high-protein, low-carb diets like Atkins could be damaging to the kidneys, but a new study found that this isn’t the case in otherwise healthy patients.

Researchers from the Indiana University School of Medicine compared the effects of such a diet to that of a standard low-fat diet in 307 obese people who did not suffer from kidney disease or other chronic illnesses.

After a two-year period, they found that the high-protein, low-carb diet didn’t cause noticeable harmful effects on healthy obese patients’ kidney function compared to obese people who followed a low-fat diet.

“Despite decades of concerns about low-carb, high-protein diets that may cause kidney damage in healthy people, there were no signs that this would be the case after a two-year period,” said Dr. Allon Friedman, lead author of the study, published in the Clinical Journal of the American Society of Nephrology.

Protein in the blood contributes to important protective benefits to the body, including fighting infections, blood clots and improving circulation in the body.  Normally, proteins are too big to pass through the kidneys’ filter into the urine, but proteins from the blood can leak into the urine when kidney filters are damaged, according to the National Institutes of Health.

Abnormal amounts of protein in the urine, known as proteinuria, usually point to some sort of kidney disease, regardless of diet.  But, researchers found that the most important way to reduce protein in urine did not have to do with the type of diet but rather the actual amount of weight lost.

The results are relevant to the millions of healthy obese adults who use dieting as a weight-loss strategy, researchers noted.  More than one-third of American adults are obese, according to the Centers for Disease Control and Prevention.

Despite the promising results, Dr. Joseph Vassalotti, chief medical officer of the National Kidney Foundation, cautioned people to take the findings with a grain of salt.

“The population studied does not apply to most patients with or at risk for chronic kidney disease, since the study participants had no evidence of chronic kidney disease or other illnesses,” said Vassalotti.

“The best diet is obviously one that is balanced, that reduces calories and encourages daily exercise,” said Friedman.  “For this study, we really showed that it’s not important how someone loses weight, but whether they can do it and keep it off.”

Copyright 2012 ABC News Radio

Friday
Oct282011

New York Man Pleads Guilty to Organ Trafficking

Jupiterimages/Thinkstock(NEW YORK) -- A Brooklyn, N.Y., man admitted in court Thursday that he purchased human kidneys from live Israeli donors that were ultimately transplanted into three New Jersey residents.

Levy Izhak Rosenbaum, 60, earned $410,000 from the three black-market sales and was conspiring to broker another deal when he was caught, federal prosecutors said in a statement. He received another $10,000 as down payment for that transaction.

Rosenbaum’s attorneys, Ronald Kleinberg and Richard Finkel, issued a statement saying their client’s motivation was to save the lives of people who would have died without the transplants because more than 90,000 Americans are on transplant waiting lists.

“The transplants were successful and the donors and recipients are now leading full and healthy lives,” the attorneys said.  “In fact, because of the transplants and for the first time in many years, the recipients are no longer burdened by the medical and substantial health dangers associated with dialysis and kidney failure.”

But New Jersey U.S. Attorney Paul Fishman called Rosenbaum’s actions “an affront to human dignity” and said these black-market organ sales offer an unfair, life-saving advantage to people who can afford to buy organs.

Rosenbaum, an Israeli citizen, admitted the sales took place between 2006 and 2009.  He was ultimately caught in a sting involving the FBI and a woman who told Rosenbaum her uncle needed a kidney transplant. According to prosecutors, Rosenbaum told the woman he knew the organ sales were illegal, but he had been in the business a long time. They agreed on a price of $150,000, part of which he said was to pay individuals for their part in finding a donor.

He faces three counts related to the kidney brokering and another count of conspiracy.  He could spend up to 20 years in prison and have to pay a stiff fine. He will also pay back the $420,000 he earned and is under house arrest until he is sentenced in February.

Prosecutors did not name the hospitals where the transplants took place, but as for whether the institutions should hold any accountability, Dr. Linda Chen, surgical director of the Live Donor Kidney Program at the University of Miami’s Miller School of Medicine, said it is difficult to determine whether individuals are being honest about where organs come from.

Chen also said that because waiting lists for kidneys across the country are so long -- it is about two-and-a-half years in Florida and seven to nine years in New York -- it makes sense that there is such a profitable black market out there.

“But this is a big blow for the transplant community,” she said. ”We need to get the right message out there about the fact that it’s a highly regulated process governed by the United Network for Organ Sharing and the Organ Procurement and Transplantation Network.”

Chen also said there could be safety issues involved with internationally acquired organs.

“It’s always a safety issue,” she said. ”How long can a kidney remain in a box while it’s transported? There could be issues with prolonging preservation time.”

Copyright 2011 ABC News Radio

Thursday
Oct062011

Experimental Protocol May Eliminate Need for Immunosuppressants

Owen Franken/Getty Images(STANFORD, Calif.) -- One of the biggest complications associated with organ transplants is the need for lifelong use of immunosuppressants to prevent rejection, which typically cause a number of serious side effects.

But a recently developed post-kidney transplant regimen developed by doctors at the Stanford University School of Medicine could make it possible for patients to live without the need for immunosuppressive drugs.

Eight of 12 patients given the new post-transplant protocol, which consisted of radiation and donor stem cells, were able to be weaned off immunosuppressants after about six months and were able to stay off them for at least one year and, in some cases, three years.

"The majority of patients were able to discontinue antirejection medications, and all patients had excellent graft function at the last observation point," the authors wrote.

In a short letter published in the New England Journal of Medicine, the doctors described the protocol, called "induced immune tolerance," in the kidney transplant patients.

After their transplants, the patients received small doses of radiation as well as stem cells from their donors with the hope that these donor cells would mix with their own cells and be recognized by the body as their own.

So far, the patients have done well.

Transplant surgeons not involved in the Stanford research say the new therapy is very promising since a lifetime of anti-rejection medicines can involve serious complications.

"It would be great if we could do something up front and just stop the immunosuppressants," said Dr. Jonathan Bromberg, chief of the division of transplantation at the University of Maryland Medical Center in Baltimore. "They can hurt the kidneys, can cause weight gain, high blood pressure, diabetes, make people more susceptible to infections and because they can cause high blood pressure and diabetes, they can increase susceptibility to cardiovascular disease."

Some transplant patients can live without immunosuppressive drugs, but it's not yet clear why.

"Some people have their own tolerance to the transplanted organ that develops, but we're not sure why that develops in some people and not others," said Dr. Michael Porayko, medical director of liver transplantation at Vanderbilt University Medical Center in Nashville.

While being able to avoid the harmful effects of immunosuppressants is a huge benefit of this new regimen, there are also potential drawbacks.

"The downside is you have to irradiate people. You could have problems later on because radiation in its own right can cause problems," said Dr. Lewis Teperman, chief of transplant surgery at NYU Langone Medical Center in New York.

Dr. George Burke, professor and director of Lillian Jean Kaplan Renal Transplantation Center at the University of Miami's Miller School of Medicine, said he's cautiously optimistic about the research. He believes future studies should address, among other things, the role of other types of immune cells called memory T cells.

Copyright 2011 ABC News Radio







ABC News Radio