Friday, October 20

Aggressive treatment for Mourning


Though the kidney disease that has sidelined Miami Heat center Alonzo Mourning for the 2000-2001 basketball season is far better understood by doctors than it was 10 years ago, it still is considered a serious condition that requires aggressive treatment to arrest.

Doctors said on Oct. 16 that Mourning was suffering from focal glomerulosclerosis (FGS), which is a disease that affects the filters of the kidney responsible for removing toxins from the urine. There are about two million of these dot-like structures in the outer rim of the kidney, not unlike leafs on a tree branch.

"What happens with this disease is that these leaf structures get smudged with deposits of a material that basically destroys parts of these branches," says Dr. Toby Gottheiner, a Palo Alto, Calif.-based nephrologist and clinical associate professor at Stanford University.

Pinning down the causes of FGS has proved difficult. The majority of cases are idiopathic, which is to say they have no known cause. Extreme obesity has occasionally been associated with the disease, as have HIV and heroin use. Long-term use of anti-inflammatory drugs also has been suggested as a contributing factor in some forms of kidney disease, though Dr. Gottheiner said this would be considered unusual.

"To get kidney disease from anti-inflammatories, you would need large, large amounts over long, long periods of time," he said. Further clouding the picture is the fact that FGS usually does not produce symptoms, and can be diagnosed only through a kidney biopsy, which often is performed in response to the presence of protein in a patient's urine.

If left untreated, the disease can spread throughout the kidney until the whole kidney function is destroyed. According to Dr. Gottheiner, this can occur over a span of two to three years in the more aggressive forms of the condition, or as long as 10 years.

"Ultimately, you're left with a person requiring kidney replacement therapy, be it dialysis or transplantation" in these cases, he said. "And, unfortunately, there is a fairly high incidence of recurrent disease in the transplant kidney. About 30 percent of patients will get recurrent disease."

Up until about 10 years ago, FGS was considered an untreatable disease, and doctors focused on treating patients' symptoms, such as high blood pressure. But studies found that the condition responded well to steroid treatments, and today approximately 50 to 60 percent of patients go into partial or complete remission. In addition to steroids, patients commonly are prescribed angiotensin-converting enzyme (ACE) inhibitors, and are put on salt and protein restriction.

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