Blog entry by Meguid El Nahas
DR SAMAH IDRISS REPORTED FROM EDAT-ERA 2014:
EUROTOX GRAND SESSION
PROF R Vanholder and G. Glorieux
Uremic toxins are more like established Gut Kidney axis with effect on mechanisms with impact on survival and quality of life of CKD patients :
progression of CKD
Protein bound uremic toxins :
1-Hippurate ( inhibits uremic glucose utilization and involved with muscle weakness in uremic patients, also in CSF responsible for neurological symptoms in old literatures !!!! )
New studies on Rat models of CKD shows that it accelerate tubular injuries , glomerular dysfunction and glomerulosclerosis..
2- Phenylacetic acid impairs macrophage functions and involves in inflammation -oxidative burst theory and inhibiting iNOS .
GUT KIDNEY AXIS determinants :
Nutrient availability (Carbohydrates and Nitrogenous molecules ) +colonic transit time ( specially with HD patients having prolonged colonic transit time )+ composition of colon microbiota (CKD alters intestinal flora )
Possible interventions :
Protein restriction(CKD 3-5 ND)
food supplement (pre and pro synbiotics ) !!!
pharmacological therapies to alter GI physiology(acarbose)
Avoiding therapies slowing down the transit time /
removal of protein bound toxins by combined fractional plasma separation and adsorption techniques (FRAD vs HF HD)
As many are of microbial origins so to prove causal relations for sure ... we should focus on intestinal generation , tubular secretion ,novel approaches in dialysis to decrease the circulating levels .
UREMIC TOXINS...THE LOCH NESS MONSTER OF NEPHROLOGY...REARS ITS HEAD EVERY NOW AND THEN...AND THEN DISAPPEARS WITHOUT TRACE OR IMPACT....WHEN WILL THOSE WHO SEARCH FOR THE HOLY GRAIL OF UREMIA TO REALISE THAT CKD IS NOT A SINGLE MOLECULE DISEASE BUT INSTEAD...A COMPLEX MULTISYSTEM...MUTLI-MEDIATORS...INTER-RELATED SYSTEMIC DISEASE....
I RECALL THE LATE PROFESSOR JONAS BERGSTROM IN THE 70-80s...SEARCHING FOR THE UREMIC TOXIN(S)...IN THOSE DAYS...MIDDLE MOLECULES...FOR SOME REASON...NOT SMALL...NOT LARGE...BUT MIDDLE MOLECULES...WAS THE ANSWER TO ALL OUR TROUBLES WITH UREMIA...
HE LIVED....PUBLISHED...AND DIED...AND MIDDLE MOLECULES ADDED NOTHING BUT CONFUSION TO NEPHROLOGY...
I FEAR THE SAME MAY BE SAID ABOUT PROF VANHOLDER ONE DAY...I SINCERELY HOPE TO BE PROVED WRONG...
THE URMEIC TOXINS CHASERS ARE CHASING RAINBOWS...
OR THE LOCH NESS MONSTER (please note that I am on holiday near a Scottish Loch...hence this analogy...)