Since the discovery of Hemoglobin S (HbS) by Linus Pauling and colleagues in 1949 and identification of the abnormality in the amino acid sequence by Vernon Ingram in 1956 (replacement of the hydrophilic glutamic acid at position 6 in the ?-globin chain by the hydrophobic valine residue), it has been known that the abnormal polymerization of deoxy-HbS is the main cause for vaso-occlusive crisis involving many organs including the kidneys in sickle cell disease (SCD).

Advances in understanding of RBC dehydration, role of nitric oxide, adenosine, and changes in RBC and plasma membrane proteins during sickling have advanced our current understanding of SCD.

Medullary renal carcinoma (MRC) is a rare and fatal cancer that occurs primarily in patients with sickle cell trait (SCT) and sickle cell disease (SCD). The typical patient with MRC is a young male (mean age of 22 years) of African or Mediterranean descent.  Most patients with this disease present initially with gross hematuria, weight loss, or abdominal pain.

In symptomatic patients, 80% will have retroperitoneal lymphadenopathy and visceral metastasis. The disease is uniformly fatal, with a life expectancy from the time of initial diagnosis of only 15 weeks. There are no known effective radiation or chemotherapy treatments for the disease.

The renal manifestations of SCD are not limited to MRC. The hypertonic, acidic and hypoxic environment in the inner medulla favors RBC sickling, leading to occlusion and necrosis of the vasarecta. The resulting ischemia leads to release of vasodilators such as prostaglandin.

This, in turn, increases the glomerular filtration rate (GFR), leading to microalbuminuria, proteinuria, and eventually low GFR, particularly among patients in the fourth decade of life. Sickle cell patients can have supranormal proximal tubular function resulting in increased creatinine secretion and hyperphosphatemia. Such patients can also have impaired distal hydrogen ion potassium secretion.

Diminished urinary concentrating ability is one of the early renal involvements in SCD and this is often irreversible after age 10. Less severe, impaired urinary concentrating ability is also seen in patients with SCT, which is a benign carrier condition in which one  sickle cell beta globulin gene is inherited along with a normal beta globulin gene.

The prevalence of SCT is as high as 8%-10% in African Americans. Hematuria is common in both patients with SCD and SCT and could be from papillary necrosis, renal infarct, or medullary renal carcinoma, which is seen more often in those with the trait.

Investigation has focused on why MRC behaves so aggressively. Data support that chronic renal medullary hypoxia may play a role in tumorigenesis. Conditions in the renal medulla, including low oxygen tension, high acidity, and high osmolarity, promote sickling of red cells in patients with SCT. Sickled cells conglomerate and occlude capillaries.

This leads to tubular epithelial hypertrophy and hyperproliferation. The nature and extent of mutations in MRC are variable, but the net result is activation of the hypoxia-inducible factor 1 pathway.

Clinical strategies are limited currently to prevention and early detection. Medullary hypoxia in these patients may be lessened with daily bicarbonate supplementation and increased fluid hydration. General screening for MRC would be difficult to justify given the high cost of imaging and the low incidence of disease. 

Patient selection for screening plays a clear role. Most young males with SCT have gross hematuria with associated papillary necrosis or hypertrophy. 

Cross-sectional imaging with and without contrast is mandatory in these patients as part of their formal hematuria evaluation. It could be argued that these patients be placed on a surveillance protocol involving annual renal US.  There is no current data to support that early detection impacts survival of MRC.

Indeed, there are no data that describe outcomes of curative-intent surgery for low-stage localized MRC. Nonetheless, in young patients with SCT and gross hematuria, surveillance seems a prudent course of action.

Matthew Simmons, MD, is in the Department of Urology and Surafel Gebreselassie, MD, is in the Department of Nephrology at the Cleveland Clinic's Glickman Urological and Kidney Institute.

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NASHVILLE, Tenn., April 2, 2012 -- /PRNewswire/ -- DSI Renal (or Dialysis Newco, Inc.), a leading provider of dialysis services for patients suffering from chronic kidney failure, announced today that it has acquired 54 dialysis clinics from Fresenius Medical Care AG & Co. KGaA.  The DSI acquisition, driven by a Federal Trade Commission (FTC) divestiture order associated with the recent Fresenius acquisition of Liberty Dialysis Holdings, officially closed on March 30, 2012[1], making DSI the fourth largest for-profit provider of outpatient dialysis services in the United States.  With the close of the DSI/Fresenius Medical Care transaction, DSI Renal now operates 85 dialysis centers as well as home and acute care programs across 23 states, providing care to more than 6,500 patients.

"This acquisition is transformative for DSI in that we are establishing a larger, national focus and footprint," said Craig Goguen, President and Chief Executive Officer of DSI Renal.  "On a local level, we're creating jobs that will bolster Nashville's economy, and we're also helping to foster competition in markets across the country for thousands of people who rely on clinics like ours to provide life-saving dialysis treatment."

"Regardless of size, we will continue to focus on delivering a high level of service to our physician partners so that together we can provide exceptional care for our patients.  Our added scale will allow DSI to further invest in new and existing partnerships with nephrologists, to broaden our relationships with payers and suppliers, and to facilitate ongoing recruitment and retention of the best dialysis industry caregivers."

DSI's management team has experience in the integration of dialysis clinics, as DSI was formed through a similar acquisition in October 2011.  The company was reorganized by Frazier Healthcare and New Enterprise Associates (NEA), in partnership with Bob Lefton and Craig Goguen, DSI Renal's Executive Chairman and CEO, respectively, when it acquired 30 clinics from DaVita and the former DSI Renal Inc. through a separate FTC-mandated divestiture.  The new platform company, DSI Renal, remained in Nashville with the company name, newly appointed Goguen at the helm and the former DSI management team still largely intact.

"DSI's leadership team collectively has hundreds of years of experience in the dialysis industry and we have positioned the company for rapid growth," said Goguen.  "We are confident that our highly scalable infrastructure will support a largely seamless integration of these new sites, as well as further opportunities for expansion through de novo clinic creation, new joint venture partnerships with physicians and acquisition of additional established clinics in targeted geographies."

Over the last year, DSI Renal has become one of the fastest-growing dialysis companies in the United States.  Prior to the October 2011 acquisition of DSI by DaVita, DSI's management team oversaw operations of 106 free-standing dialysis clinics serving 8,000 patients, and continues to oversee the growth of the business from its corporate offices in Nashville.  DSI is funded by the Company's management and two leading private equity firms—Frazier Healthcare and New Enterprise Associates.

"From a standing start, in only eight short months, Frazier and NEA have helped create the #4 player in the for-profit dialysis clinic business.  It has been a pleasure working with the DSI team in putting this platform together.  None of this would have been possible without the leadership of our world class management team in Nashville and we look forward to executing on our aggressive growth plans," said Ben Magnano, Principal at Frazier Healthcare.

Mohamad Makhzoumi, Partner at NEA, added, "The broader fundamentals remain compelling when considering that dialysis care lacks any clinical need controversy, faces limited therapeutic alternatives and remains a recession-resistant industry where demand for treatment is steady, predictable and not overly dependent on macroeconomic factors.  In the midst of this stable environment and dynamically mounting demand, the DSI team has built a potentially transformative company to better serve the vast number of patients suffering from end-stage renal disease."

About DSI Renal

DSI Renal is a leading provider of dialysis services in the United States, offering state-of-the-art treatment for patients suffering from chronic kidney failure and renal disease.  Together with its physician partners, DSI Renal owns and operates 85 dialysis clinics in 23 states.  The company plans for growth through acquisition and development of new clinics as well as through establishment of additional joint venture partnerships with leading nephrologists for the clinic, hospital and alternate settings.  For more information, please visit www.dsi-corp.com.

About Frazier Healthcare

Founded in 1991, Frazier Healthcare is a leading provider of growth equity and venture capital to high growth and emerging healthcare service, biopharma and medical device companies.  With over $1.8 billion under management across seven funds, Frazier Healthcare has invested in more than 100 companies across the entire developmental spectrum.  From seed stage venture investments to leveraged recapitalizations of cash generating companies, Frazier Healthcare has established itself among entrepreneurs and seasoned executives as a preferred partner to help create and grow successful healthcare companies. For more information about Frazier Healthcare, visit the company's website at www.frazierhealthcare.com.

About NEA

New Enterprise Associates, Inc. (NEA) is a leading venture capital firm focused on helping entrepreneurs build transformational businesses across multiple stages, sectors and geographies.  With approximately $11 billion in committed capital, NEA invests in information technology, healthcare and energy technology companies at all stages in a company's lifecycle, from seed stage through IPO.  The firm's long track record of successful investing includes more than 170 portfolio company IPOs and more than 290 acquisitions.  In the U.S., NEA has offices in the Washington, D.C. metropolitan area; Menlo Park, California; and New York City.  In addition, New Enterprise Associates (India) Pvt. Ltd. has offices in Bangalore and Mumbai, India and New Enterprise Associates (Beijing), Ltd. has offices in Beijing and Shanghai, China.  For additional information, visit www.nea.com.

[1] Official closing dates for clinics in Hawaii and New York will vary based on state regulatory procedures.

Corporate Contact:Giles WardDSI Renal(615) 777-8200 This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Media Contact:Angela NovakCorner Office Communications(615) 406-0715 This e-mail address is being protected from spambots. You need JavaScript enabled to view it

SOURCE DSI Renal

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Dissolve renal calculi naturally without harmful lithotripsy or surgery

London, UK (PRWEB) April 01, 2012

New Thermobalancing Therapy is the safest way to get rid of kidney stones avoiding harmful expensive kidney stones removals with ESWL or a surgery and, moreover, save thousands of dollars, states Fine Treatment. Dr. Allen’s Device for Kidney Care with the price less than $130 can save thousands of dollars but what is more important prevents people’s general health from the severe complications, caused by the mainstream methods of kidney stone removal.

The National Institutes of Health (NIH) published a conclusion made by researches from the Mayo Clinic: “At 19 years of follow-up SWL for renal and proximal ureteral stones was associated with the development of hypertension and diabetes mellitus. The incidence of these conditions was significantly higher than in a cohort of conservatively treated patients with nephrolithiasis.”

Unlike ESWL, the new therapy dissolves any type and size of renal calculi quietly without complications. This video, for instance, confirms that Dr. Allen’s device dissolves even a huge kidney stone: http://www.youtube.com/watch?v=EOMUqHVrSfk. Furthermore, Dr. Allen’s therapeutic device with the price less than $130 can save thousands of dollars.

According to the New Choice Health, Medical Costs Comparison, “Medical procedure prices for lithotripsy (kidney stone removal surgery) vary tremendously. Most expensive lithotripsy is in Minneapolis = $29,000. New York, NY lithotripsy cost average - $16.300; Los Angeles, CA lithotripsy cost average – $20.500.”

“Fine Treatment offers the cost effective therapy that dissolves renal calculi without adverse side effects and saves tens of thousands of dollars which men or women can spend any way they wish,” says Dr. Allen. “There is no logical explanation why people have to pay thousands for ESWL and get severe diseases, such as high blood pressure or diabetes in the future, so the use of ESWL must be stopped.”

Further information on how to dissolve renal calculi naturally can be found at the Fine Treatment website, http://www.finetreatment.co.uk/kidneystonestreatment/dissolvekidneystone.html.

About Dr. Simon Allen and Fine Treatment:
Dr. Simon Allen is a highly experienced medical professional. His specialty is in the internal medicine and cardio-vascular field, and he has treated patients after a heart attack, with kidneys problems, including kidney stones disease, prostate and spine conditions. Fine Treatment exclusively offers Dr Allen’s devices for prostate treatment: chronic prostatitis and BPH, coronary heart disease, kidney stones, back pain and sciatica relief.

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