Thanks to antibiotics, we tend to think of urinary tract infections as no big deal. Pop some cipro, and you’re done. A good thing, too—if the E. coli that usually cause UTIs crawl up the urinary tract, they can cause kidney failure and fatal blood poisoning.
But antibiotics may not be saving us from UTIs for very much longer. Scientists tracking UTIs from 2000 to 2010 found a dramatic uptick in cases caused by E. coli that do not respond to the drugs that are our first line of defense. In examining more than 12 million urine analyses from that period, they found that cases caused by E. coli resistant to ciprofloxacin grew five-fold, from 3% to 17.1% of cases. And E. coli resistant to the drug trimethoprim-sulfame-thoxazole jumped from 17.9% to 24.2%. These are two of the most commonly prescribed antibiotics used to treat UTIs. When they are not effective, doctors must turn to more toxic drugs, and the more those drugs are used, the less effective they in turn become. When those drugs stop working, doctors will be left with a drastically reduced toolkit with which to fight infection.
Could a blast of radio waves keep the hypertension away? For patients whose high blood pressure doesn’t respond to regular medication, a treatment reported in The Lancet aims to do just that.
The minimally invasive procedure is similar to angioplasty for heart disease but involves deactivating nerves in the kidney which play a key role in regulating blood pressure. A catheter is inserted into the femoral vein in the thigh and threaded through to the kidney. Then a burst of radio-frequency energy is used to disable the nerves [The Independent].
Normal systolic blood pressure is considered 120; hypertension is defined as being over 140. In this trial, the team led by Murray Esler studied the effect of the radio treatment on more than 100 people who had very high levels—an average of 178—despite taking high blood pressure medication.
After six months, the systolic blood pressure had fallen by at least 10 mmHg in 84 per cent of those who received the treatment. This is expected to reduce their risk of stroke by more than 30 per cent. Esler is unsure why it was not effective for all patients. He speculates that some were not “zapped enough”. [New Scientist]
Dialysis can be a life-saver for people with kidney failure, but according to a major investigation, the way we do it and finance it in this country is a total mess.
Writing in The Atlantic, reporter Robin Fields of the nonprofit investigate journalism group ProPublica lays out her long investigation into dialysis. Though the procedure since 1972 has been the only one guaranteed universal coverage to all Americans through Medicare, Fields finds it disturbingly inefficient, with one in four American patient dying within a year of beginning treatment:
Now, almost four decades later, a program once envisioned as a model for a national health-care system has evolved into a hulking monster. Taxpayers spend more than $20 billion a year to care for those on dialysis—about $77,000 per patient, more, by some accounts, than any other nation. Yet the United States continues to have one of the industrialized world’s highest mortality rates for dialysis care. Even taking into account differences in patient characteristics, studies suggest that if our system performed as well as Italy’s, or France’s, or Japan’s, thousands fewer kidney patients would die each year. [The Atlantic]
How did things go so awry? Medicare mandated coverage, the investigation finds, but it did not properly mandate how the clinics spent Medicare’s money.
Researchers have designed the first artificial kidney small enough to slip comfortably inside the human body, and they say the technological breakthrough could be an enormous benefit for people grappling with kidney disease. Modern medicine can keep patients alive if their kidneys fail via external dialysis machines that filter toxins from their blood, but it’s a grueling and imperfect process.
Patients must be tethered to machines at least three times a week for three to five hours at a stretch. Even then, a dialysis machine is only about 13 percent as effective as a functional kidney, and the five-year survival rate of patients on dialysis is just 33 to 35 percent. To restore health, patients need a kidney transplant, and there just aren’t enough donor organs to go around. In August, there were 85,000 patients on the U.S. waiting list for a kidney … while only 17,000 kidney transplants took place last year. [Technology Review]
A woman with kidney disease has died after receiving an experimental stem cell treatment at a private clinic in Thailand, and a postmortem examination of her kidneys revealed that the treatment was almost certainly responsible for her death. Last week we reported that Costa Rica’s health ministry had closed a stem cell clinic that catered to foreigners, which sparked lively debates around the Internet about whether patients should be able to willingly take on risks associated with experimental treatments. This new case offers a sobering reminder of what can happen when patients travel abroad looking for a miracle cure.
The woman suffered from lupus nephritis, a disease in which the immune system attacks the kidneys. When medications no longer controlled her disease, she went to a still-unnamed clinic in Bangkok where doctors said they could treat her disease using stem cells drawn from her own bone marrow. There was some medical rationale for this:
Bona-fide trials in European clinics about six years ago showed that some people with similar kidney disease benefited if stem cells from their own bone marrow were injected into their blood. The body’s immune system was first deliberately destroyed with powerful immunosuppressive drugs, then the reinjected stem cells helped to stop the attacks on the kidney by rebuilding and rebalancing the immune system. [New Scientist]
However, the Thai clinic didn’t inject the stem cells into the patient’s blood stream, instead they injected them directly into her kidneys. That means the stem cells did nothing to stop the immune system’s attack on the organs–and they instead produced never-before-seen side effects.
Blood vessels grown from patients’ own skin cells have been used to make the process of dialysis safer and easier for people with failing kidneys, and researchers say the process may one day be used to custom-produce blood vessels for patients with circulatory problems in their hearts or legs [AP].
Kidney patients need frequent dialysis to filter their blood, and that requires a vessel, or shunt, to connect them to dialysis machines. This can be made from their own vessels. But because dialysis is done so regularly, kidney patients often run out of healthy vessels and need an artificial one, often made out of [Gore-Tex]. Those are prone to infection and inflammation [AP].
For the new study, published in The Lancet, researchers took small snips of skin from the backs of ten patients’ hands and extracted two cell types — fibroblasts from the skin which provide the structural backbone of the vein, and endothelial cells to form the lining of the vein [Reuters]. In the lab, those cells were grown into sheets of tissue that were then rolled into tubes measuring about six inches long, which then fused at the seams. Those tubes were essentially new blood vessels. The whole process took between six to nine months.