Dyad Three (3)
Byron Webb A. Romero
Von Deneb H. Vitto
Raymond C. Ursal

Activity/ Exercise

Patients with GN are advised to avoid strenuous activities since this can aggravate proteinuria, hematuria, and cylinduria or urine casts. These patients can resume activities but may need to have close or further follow up or consultation with their health care provider according to Papanagnou, 2008). For patients with post streptococcal GN, bed rest is recommended to prevent hematuria (Schach, 2006).

References:

Papanagnou, D. (2008). Acute Glomerulonephritis, Emedicine Genitourinary. Retrieved July 1, 2008, from http://www.emedicine.com.

Schacht, R., Kim Y.S. , Travis, L., Acute Poststreptococcal Glomerulonephritis, emedicine nephrology, 2007

Response: ACTIVITY
By: Dyad2- Gil Legarda and Joanalyn Balino

Decreased Maximal Aerobic Capacity in Pediatric
Chronic Kidney Disease
Donald J. Weaver, Jr., Thomas R. Kimball,Timothy Knilans,Wayne Mays,
Sandra K. Knecht, Yvette M. Gerdes, Sandy Witt, Betty J. Glascock, Janis Kartal,
Philip Khoury, and Mark M. Mitsnefes

Weaver, D., Kimball, T. et al. made a study in order to determine maximal aerobic capacity(VO2 max) in pediatric patients with different stages of CKD and to evaluate the associations of VO2 max with left ventricular(LV) mass, and left ventricular (LV) diastolic and systolic function.They wanted to test their hypothesis there is an early effect on oxygen utilization and decreased cardiopulmonary reserve in altered LV structure and function in children and adolescents with mild to moderateCKD. Also to find out that in this particular age group, impaired maximal aerobic capacity becomes more severe as End stage renal disease (ESRD) is reached A total of 113 participants involved in the study. 46 have Chronic stage 2 to 4 (glomerular disease) . 12 Participants on maintenance hemodialysis. 22 Participants had transplant. And the remaining 33 were healthy children (control group). The Inclusion criteria were: (1) age 6 to 20 yr; (2) measured GFR 16 to 89 ml/min per 1.73 m for CRI patients;(4) for dialysis patients, at least 6 wk of maintenance dialysis; (5) absence of congenital, structural, or primary myocardialdisease; (5) good quality echocardiographic images. Subjects underwent recumbent ergometer maximal exercise test using the James protocol. Immediately before and after exercise, echocardiographic parameters were assessed. Oxygen consumption (VO2 max) was measured using a metabolic cart at rest and during each stage of exercise.


Mean maximal aerobic capacity (VO2) max was similar in height/weight-matched controls 37.5-4.8 ml/kg per min, subjects in age-matched control 38.7 -5.4 ml/kg per min and Chronic kidney Disease stage 2 38.6 - 11.9 ml/kg per min groups (P =0.61). In the analysis utilizing age-matched controls, VO2 max remained significantly lower in CKD stage 3 and 4, hemodialysis and transplant subjects when compared with height/weight-matched controls (P = 0.0001). There is no significant relationship between VO2 max and BMI using z-scores analysis (r-0.09, P -0.33). Same result was seen (no relationship) with absolute BMI values after VO2 max was adjusted to estimated LBM (r=0.06, P =0.65). Maximal aerobic capacity VO2 max was negatively correlated with resting HR and BMI but not BP or maximal HR.


The degree of decrease in maximal aerobic capacity (VO2 max) in patients with CKD 3 to 4 was similar to that of patients on maintenance hemodialysis and decreased diastolic function was an independent predictor of worse VO2 max. This study provides new evidence that abnormally low maximal aerobic capacity VO2 max is already present in children and adolescents with CKD stage 3 to 4. This evidence suggests that the cardiovascular system’s response to metabolic challenge is attenuated early in the development of CKD.


Weaver, D., Kimball, T. et al.(2008). Decreased Maximal Aerobic Capacity in Pediatric Chronic Kidney Disease.J Am Soc Nephrol 19: 624–630. Retrieved July 3, 2009 from http://jasn.asnjournals.org/cgi/content/full/19/3/624

Acute Renal Failure with Severe Loin Pain and Patchy Renal Ischemia after Anaerobic Exercise in Patients with or without Renal Hypouricemia
Isao Ishikawa

Division of Nephrology, Department of Internal Medicine, Kanazawa Medical University Uchinada, Ishikawa, Japan

Nephron 2002;91:559-570 (DOI: 10.1159/000065013)

Acute renal failure induced by rhabdomyolysis after strenuous exercise is well known. We describe here a new type of acute renal failure with severe loin pain which develops after anaerobic exercise (ALPE), for example, 200-meter track racing. The patients complained of severe loin pain several hours after exercise and presented at the emergency room. Since our first description 118 cases have been reported. The serum creatinine concentration was 4.7 ± 2.9 mg/dl (mean ± SD) at the initial examination and 6.0 ± 3.0 mg/dl at maximum. Forty-nine of 96 cases whose serum uric acid levels were described revealed renal hypouricemia (51.0%). A specific risk factor is suggested by the fact that acute renal failure recurred after exercise in 20 of 118 cases. The creatine phosphokinase and serum myoglobin concentrations were normal or only slightly elevated, suggesting damaged type 2 muscle fibers. Renal computed tomography scans, performed several hours to 1-2 days after contrast medium administration, revealed multiple wedge-shaped areas of contrast enhancement. Forty-six of 50 cases examined by delayed computed tomography scan revealed bilateral wedge-shaped contrast enhancement. Although less efficient, radioisotopic scans, such as a methylene diphosphonate bone scan, have also been employed to detect patchy accumulation of isotopes in the kidneys (12 of 19 cases). The pathogenesis of ALPE may be patchy vasoconstriction of the renal vessels, because of its wedge-shaped distribution and its reversibility. Such vascular spasm would account for the renal pain. The prognosis was good, although 20 of 109 cases required dialysis treatment. In conclusion, there are two types of exercise-induced acute renal failure: one is the well-known myoglobin-induced acute renal failure, and the other is ALPE that may be nonmyoglobin induced or induced by myolysis of type 2 muscle fibers due to anaerobic exercise. One hundred and eighteen cases of ALPE were collected from the literature, and half of the cases were found to display renal hypouricemia.

A meta-analysis on a therapeutic dilemma: to exercise or not to exercise in cachexia
Barbara Perniconi, Maria C. Albertini (1), Laura Teodori (2), Laura Belli, Marco Rocchi *(3), Dario Coletti


Having a good exercise program will provide important benefits on preventing several diseases including renal disorders. There is a significant reason to recommend regular physical activity in different patients, but it may not be that good for a patient suffering from chronic disease. A condition called Cachexia, a severe muscular wasting syndrome involving mostly the skeletal muscles, is often related to numerous chronic illnesses including renal failure. So the question whether to do exercise or not becomes a stimuli for research. This study was conducted using meta-analysis on different research papers from the past decades dealing with exercise done by cachectic patients. 50 full text research papers was included in the study which contains a review based on the assessment of the effects of exercise on biological parameters related to cachexia. Any chronic disease known to have connection with cachexia was included in the study.

With the target to determine whether physical exercise can be beneficial or not for muscle homeostasis and function, the meta-analysis pooled several studies conducted to patients with chronic illness. Studies show that physical exercise has a significant effect on cachexia considering that it is usually associated with RA. It can be concluded that physical activities can be beneficial on muscle wasting. Cachexic clients may utilize certain types of exercise which can be the most suitable for their condition. This includes resistance training, but not necessarily means endurance training. Prolonged resistance training can significantly counteract muscle wasting and loss in cachexia among patients with chronic diseases.

Knowing the suitable exercise for a client experiencing cachexia can now delimit the client in performing daily activites. There would be more opportunities for the client to live his/her life to the fullest without compromising his/her chronic condition. It is recommended that future studies be made including open clinical trials related to exercise as an intervention for cachexia. The result of this study may be used to provide conclusive evidences for that matter.

References:
Authors and Disclosures
Department of Histology and Medical Embryology, Sapienza University of Rome and IIM, Interuniversity Institute of Myology; (1) Institute of Biological Chemistry, University of Urbino “Carlo Bo”, Italy; (2) Biotec-Med, ENEA-Casaccia, Rome, Italy; *(3) Corresponding Author, Institute of Biomathematics, University of Urbino “Carlo Bo”, Italy
Basic Applied Myology 18 (5): 115-120, 2008

Dyad 6 guomanman and chenya

fitness for GN patients

Physical fitness is very important in today's world. Everyone is enjoying the benefits of greater strength and feeling better. Exercise keeps your body strong and healthy.

With exercise, it becomes easier to get around, do your necessary tasks and still have some energy left over for other activities you enjoy.

In addition to increased energy, other benefits from exercise may include:

* improved muscle physical functioning
* better blood pressure control
* improved muscle strength
* lowered level of blood fats (cholesterol and triglycerides)
* better sleep
* better control of body weight.

Choose continuous activity such as walking, swimming, bicycling (indoors or out), skiing, aerobic dancing or any other activities in which you need to move large muscle groups continuously.

Low-level strengthening exercises may also be beneficial as part of your program. Design your program to use low weights and high repetitions, and avoid heavy lifting.

Exercise at least three days a week. These should be non-consecutive days, for example, Monday, Wednesday and Friday. Three days a week is the minimum requirement to achieve the benefits of your exercise.

How Hard to Work While Exercising

This is the most difficult to talk about without knowing your own exercise capacity. Usually, the following ideas are helpful:

* Your breathing should not be so hard that you cannot talk with someone exercising with you. (Try to get an exercise partner such as a family member or a friend.)
* You should feel completely normal within one hour after exercising. (If not, slow down next time.) You should not feel so much muscle soreness that it keeps you from exercising the next session.
* The intensity should be a "comfortable push" level.
* Start out slowly each session to warm up, then pick up your pace, then slow down again when you are about to finish.

The most important thing is to start slowly and progress gradually, allowing your body to adapt to the increased levels of activity.

reference

http://www.kidney.org/atoz/atozItem.cfm?id=112

DYAD 4
BALAJADIA, BOND
ZANO, ALEXIS

The Effectiveness of Intradialytic Exercise Prescription on Quality of Life in Patients With Chronic Kidney Disease

Chronic kidney disease (CKD) is a widespread medical condition that is progressive in nature. As renal function declines, the disease ultimately reaches the life-threatening end stage(ESRD), which requires urgent replacement therapy, either by dialysis or transplantation. As a result, CKD patients, many of whom have comorbid medical conditions, are severely restricted in physical, psychological, and social dimensions of life. Over the past 3 decades, research has been carried out on the effects of intradialytic exercise rehabilitation on the quality of life (QoL) of CKD patients. This review aims to critically examine the effect of exercise prescription in reducing the physical and psychological limitations encountered by CKD patients. Four studies were selected and critically appraised using specific inclusion criteria.

The results of all studies suggest a causal relationship between exercise intervention and QoL of CKD patients. Exercising patients have shown improvements in physical fitness, psychological function, manual dexterity, reaction times, and lower-extremity muscle strength. All of these factors help improve QoL.

Evidence gathered from the studies shows that exercise training has beneficial effects on the QoL of CKD patients; however, exercise is still not routinely prescribed. Further research and robust evidence are needed to overcome the limitations encountered by previous studies to confirm the positive results of exercise prescription in management of CKD.

Reference: Takhreem, Maria. The Effectiveness of Intradialytic Exercise Prescription on Quality of Life in Patients With Chronic Kidney Disease. PMC. October 2008