How mom's health may increase risk of kidney disease

ScienceDaily (Nov. 20, 2010) ? Children with Chronic Kidney Disease (CKD) are more likely to have mothers who were obese or had diabetes during pregnancy, according to a study presented at the American Society of Nephrology's 43rd Annual Meeting and Scientific Exposition, by Christine W. Hsu, MD (University of Washington, Seattle) and colleagues.

The study included more than 4,000 patients with childhood CKD -- diagnosed at age 21 or younger -- in Washington State. These patients were compared to more than 20,000 healthy children to evaluate possible relationships between a pregnant woman having diabetes, being obese or overweight, and the risk of her child developing CKD anytime during infancy, childhood, or adolescence.

The overall rate of childhood CKD was approximately 0.26 percent -- about 1 case per 400 live births. When investigators adjusted for length of gestation, CKD risk was 69 percent higher for children whose mothers had diabetes before pregnancy. For children whose mothers developed diabetes during pregnancy (gestational diabetes), there was a 28 percent increase in CKD risk. Children of obese mothers demonstrated a 22 percent increase in CKD risk.

When specific causes of kidney disease were analyzed, children whose mothers had diabetes before pregnancy had nearly a 700 percent increase in the risk of kidney-related birth defects (renal aplasia/dysplasia). "Developmental abnormalities of the kidney and urinary tract are the most common cause of childhood CKD," Hsu explains.

The risk of urinary blockage (obstructive uropathy) -- which can lead to CKD -- was increased by 34 percent for children whose mothers had gestational diabetes, 23 percent in those whose mothers were obese, and 21 percent in those whose mothers were overweight but not obese.

In adults, CKD is often related to medical conditions like diabetes and high blood pressure. In contrast, according to Hsu, "Development of childhood CKD may be programmed prenatally." Few studies have looked at possible risk factors for CKD development before adulthood.

"Our research shows that childhood CKD is modestly associated with maternal diabetes and maternal overweight or obesity, with the strongest association between abnormal kidney development and maternal diabetes," says Hsu. "Previous studies have demonstrated that maternal diabetes is associated with an increased risk of general congenital abnormalities. However, with strict control of maternal diabetes, the rate of congenital malformations is similar to that of non-diabetic mothers."

The new results raise the possibility that stricter control of diabetes and weight control during pregnancy could decrease children's risk of developing CKD. "However, this would have to be evaluated in future research," says Hsu.

The study had some limitations related to the fact that it used Washington State birth records linked to a hospital discharge database. As a result, it could only identify children with CKD who were hospitalized and had kidney disease listed in their hospital discharge diagnoses. The study definition of CKD was also broad, and the results are being reanalyzed with a stricter CKD definition. Furthermore, conclusions regarding cause and effect are not possible due to the case control design of the study.

Study co-authors include Kalani Yamamoto, MD, Rohan Henry, MD, Jordan Symons, MD, and Anneclaire De Roos, PhD (University of Washington).

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by American Society of Nephrology, via EurekAlert!, a service of AAAS.

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Inhaled steroids increase diabetes risk, study suggests

ScienceDaily (Nov. 1, 2010) ? Patients taking inhaled corticosteroids are at increased risk of developing type 2 diabetes, and more so with higher doses, say researchers at the Jewish General Hospital's Lady Davis Institute for Medical Research (LDI) In Montreal. The risk is of special concern for patients suffering from chronic obstructive pulmonary disorder (COPD), and much less significant for asthmatics.

"These medications are very effective in asthma, so the benefits clearly outweigh the risk for asthmatics," said Dr. Samy Suissa, Director of the Centre for Clinical Epidemiology at the LDI, and lead author of the study published in the American Journal of Medicine. "However, their effectiveness is questionable in COPD, where they are also used in higher doses. This is a very different risk/benefit situation."

Inhaled corticosteroids are administered in the form of aerosol sprays and micropowders, and include drugs like fluticasone (Flonase®, Advair®), budesonide (Pulmicort®, Rhinocort®) and beclometasone (QVAR®, Beclovent®), among others.

Oral corticosteroids like predinisone have long been known to increase the risk of diabetes, but this is the first time the effect has been observed with the inhaled form.

Suissa and his colleagues used the extensive databases of Quebec's provincial health insurance board to study a cohort of nearly 400,000 patients treated for COPD or asthma. They determined that inhaled corticosteroids increased the rate of onset of diabetes from 14 people per 1000 to 19 per 1000, or 34 percent, every year of use. In other words, 5 additional people for every 1000 users in the study -- people who otherwise would not have been affected -- developed diabetes from the use of the drug.

"These are not insubstantial numbers," said Dr. Suissa, also a professor of epidemiology and biostatistics at McGill University in Montreal. "Over a large population the absolute numbers of affected people are significant.

"We recommend that physicians reserve the use of inhaled steroids for the patients who truly benefit from these medications, namely asthmatics, and curb their use in COPD to the few patients for whom they are indicated. In all cases, patients using high doses should be assessed for possible hyperglycemia and the lowest effective dose targeted."

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Jewish General Hospital, via EurekAlert!, a service of AAAS.

Journal Reference:

Samy Suissa, Abbas Kezouh, Pierre Ernst. Inhaled Corticosteroids and the Risks of Diabetes Onset and Progression. The American Journal of Medicine, 2010; 123 (11): 1001 DOI: 10.1016/j.amjmed.2010.06.019

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Too much glucosamine can cause the death of pancreatic cells, increase diabetes risk, researchers find

ScienceDaily (Oct. 27, 2010) ? High doses or prolonged use of glucosamine causes the death of pancreatic cells and could increase the risk of developing diabetes, according to a team of researchers at Universite Laval's Faculty of Pharmacy. Details of this discovery were recently published on the website of the Journal of Endocrinology.

In vitro tests conducted by Professor Frederic Picard and his team revealed that glucosamine exposure causes a significant increase in mortality in insulin-producing pancreatic cells, a phenomenon tied to the development of diabetes. Cell death rate increases with glucosamine dose and exposure time. "In our experiments, we used doses five to ten times higher than that recommended by most manufacturers, or 1,500 mg/day," stressed Professor Picard. "Previous studies showed that a significant proportion of glucosamine users up the dose hoping to increase the effects," he explained.

Picard and his team have shown that glucosamine triggers a mechanism intended to lower very high blood sugar levels. However, this reaction negatively affects SIRT1, a protein critical to cell survival. A high concentration of glucosamine diminishes the level of SIRT1, leading to cell death in the tissues where this protein is abundant, such as the pancreas.

Individuals who use large amounts of glucosamine, those who consume it for long periods, and those with little SIRT1 in their cells are therefore believed to be at greater risk of developing diabetes. In a number of mammal species, SIRT1 level diminishes with age. This phenomenon has not been shown in humans but if it were the case, the elderly -- who constitute the target market for glucosamine -- would be even more vulnerable.

"The key point of our work is that glucosamine can have effects that are far from harmless and should be used with great caution," concluded Professor Picard.

The results obtained by Picard and his team coincide with recent studies that cast serious doubt on the effectiveness of glucosamine in treating joint problems.

This study was co-authored by Mathieu Lafontaine-Lacasse and Genevieve Dore.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Universite Laval, via EurekAlert!, a service of AAAS.

Journal Reference:

M. Lafontaine-Lacasse, G. Dore, F. Picard. Hexosamines stimulate apoptosis by altering Sirt1 action and levels in rodent pancreatic β-cells. Journal of Endocrinology, 2010; DOI: 10.1677/JOE-10-0243

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