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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_464"
                     title="COLUMN: &apos;Meaningful Use&apos; -- You Can Do This!"
                     score="0.011"
                     href="http://www.medpagetoday.com/Columns/18394?impressionId=1265806857007"
                     
      &lt;p&gt;Certified EHR technology used in a meaningful way is one piece of a broader Health Information Technology (HIT in techie jargon) infrastructure intended to reform the healthcare system and improve healthcare quality, efficiency, and patient safety.&lt;/p&gt;
&lt;p&gt;Under the HITECH Act, the Medicare EHR incentive programs provide payments up to $44,000 over five years to eligible professionals who are &quot;meaningful&quot; users of certified electronic health records.&lt;/p&gt;
&lt;p&gt;The Medicaid EHR program provides even bigger incentives  --  up to $63,750 over five years to practices with a 30% or higher Medicaid population for efforts to adopt, implement, or upgrade certified EHR technology or for meaningful use in the first year and up to another five years. (Pediatricians need only a 20% Medicaid patient volume to qualify.)&lt;/p&gt;
&lt;p&gt;The stimulus dollars have gotten our attention, especially in light of the eventual cuts to reimbursement scheduled to take effect in 2015 and beyond for those who don&apos;t use EHR technology.&lt;/p&gt;
&lt;p&gt;On Jan. 13, 2010 two rules were published defining the certification criteria and the criteria for meaningful use of electronic health records. (The rules are available at &lt;a href=&quot;http://www.gpoaccess.gov/fr/index.html&quot; mce_href=&quot;http://www.gpoaccess.gov/fr/index.html&quot; target=&quot;_blank&quot;&gt;www.gpoaccess.gov/fr/index.html&lt;/a&gt;.) A forthcoming rule will establish an EHR certification program. With the EHR vendors offering stimulus guarantees, the EHR certification program seems less of a concern.&lt;/p&gt;
&lt;p&gt;CMS proposed three stages of &quot;meaningful use&quot; criteria over the initial years of the program given the ongoing advancement in EHR technology and standards, as well as changes in quality measurement and other healthcare-related reporting.&lt;/p&gt;
&lt;p&gt;The focus in Meaningful Use Stage 1 is on the capture of health information in coded format and: 
&lt;ul&gt; 
&lt;li&gt;The use of it to track key clinical conditions&lt;/li&gt; 
&lt;li&gt;The communication of coded health information for care coordination purposes&lt;/li&gt; 
&lt;li&gt;Initial reporting of clinical quality measures and public health information&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The good news is that all results for all measures to be reported to CMS (for Medicare) or to the states (for Medicaid) will be done through attestation for the year 2011. In 2012, we&apos;ll be running all reports through certified EHR technology.&lt;/p&gt;
&lt;p&gt;Attestation can be achieved &quot;through a secure mechanism, such as through claims-based reporting or an online portal.&quot; But providers will still be required to &quot;use certified EHR technology to capture the data elements and calculate the results for the applicable clinical quality measures,&quot; the CMS rule said.&lt;/p&gt;
&lt;p&gt;Practices that have already implemented an EHR must ensure that their software is appropriately certified and that their clinicians are fulfilling all of the meaningful-use requirements to qualify for the incentives.&lt;/p&gt;
&lt;p&gt;So, you have just about two years to implement, iterate, rehearse, pilot, and test your own implementation against the meaningful use criteria.&lt;/p&gt;
&lt;p&gt;The initial criteria are presented in health outcomes policy priorities with associated care goals. Here are just six of the 25 criteria for Stage 1 Meaningful Use:&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Health Outcomes Policy Priority:&lt;/strong&gt;&lt;br&gt;
Improving quality, safety, efficiency, and reducing health disparities.&lt;br&gt;
&lt;strong&gt;Care Goals:&lt;/strong&gt;&lt;br&gt;
&amp;bull; Provide access to comprehensive patient health data for patient&apos;s healthcare team&lt;br&gt;
&amp;bull; Use evidence-based order sets and CPOE&lt;br&gt;
&amp;bull; Apply clinical decision support at the point of care&lt;br&gt;
&amp;bull; Generate lists of patients who need care and use them to reach out to patients&lt;br&gt;
&amp;bull; Report information for quality improvement and public reporting&lt;br&gt;

&lt;p&gt;&lt;strong&gt;Health Outcomes Policy Priority:&lt;/strong&gt;&lt;br&gt;
Engage patients and families in their healthcare.&lt;br&gt;
&lt;strong&gt;Care Goals:&lt;/strong&gt;&lt;br&gt;
Provide patients and families with timely access to data, knowledge, and tools to make informed decisions and to manage their health.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Health Outcomes Policy Priority:&lt;/strong&gt;&lt;br&gt;
Improve care coordination.&lt;br&gt;
&lt;strong&gt;Care Goals:&lt;/strong&gt;&lt;br&gt;
Exchange meaningful clinical information among professional healthcare team.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Health Outcomes Policy Priority:&lt;/strong&gt;&lt;br&gt;
Improve care coordination.&lt;br&gt;
&lt;strong&gt;Care Goals:&lt;/strong&gt;&lt;br&gt;
Exchange meaningful clinical information among professional healthcare team.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Health Outcomes Policy Priority:&lt;/strong&gt;&lt;br&gt;
Improve population and public health.&lt;br&gt;
&lt;strong&gt;Care Goals:&lt;/strong&gt;&lt;br&gt;
Communicate with public health agencies.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Health Outcomes Policy Priority:&lt;/strong&gt;&lt;br&gt;
Ensure adequate privacy and security protections for personal health information.&lt;br&gt;
&lt;strong&gt;Care Goals:&lt;/strong&gt;&lt;br&gt;
&amp;bull; Ensure privacy and security protections for confidential information through operating policies, procedures, and technologies and compliance with applicable law&lt;br&gt;
&amp;bull; Provide transparency of data sharing to patient&lt;/p&gt;

&lt;p&gt;Each of the Care Goals has defined objectives with specific measures that must be achieved to demonstrate meaningful use.&lt;/p&gt;
&lt;p&gt;Following are examples of some of the objectives and what you&apos;ll have to do to meet each.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; Maintain up-to-date problem list in ICD-9-CM or SNOMED-CT.&lt;br&gt;
&lt;strong&gt;Measure:&lt;/strong&gt; 80% for unique patients.&lt;br&gt;
This objective will enable the user to manage problem lists that span multiple visits. If you&apos;ve been billing electronically, you&apos;ve already been capturing problems in ICD-9-CM format.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; Generate and transmit prescriptions electronically.&lt;br&gt;
&lt;strong&gt;Measure:&lt;/strong&gt; Transmit 75% of noncontrolled drug prescriptions electronically.&lt;br&gt;
Did you hop on the e-prescribing incentives? You&apos;re ahead of this one! If not, you&apos;ll need to enable e-prescribing.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; Drug screening.&lt;br&gt;
&lt;strong&gt;Measure:&lt;/strong&gt; Drug screening is enabled.&lt;br&gt;
Another easy objective to meet if you&apos;ve already implemented e-prescribing. If not, you&apos;ll need to be sure your system provides real-time alerts for drug-drug interactions and drug allergy contraindications, has an electronic formulary check, maintains drug-drug and drug-allergy warnings, and tracks the number of alerts that were responded to.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; Maintain active medication list.&lt;br&gt;
&lt;strong&gt;Measure:&lt;/strong&gt; 80% for unique patients.&lt;br&gt;
You&apos;ve been doing this too with your e-prescribing implementation. The system must be able to manage an active medication list and a medication history that spans multiple visits.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; Record demographics.&lt;br&gt;
&lt;strong&gt;Measure:&lt;/strong&gt; 80% for unique patients, including ALL data elements. Denominator is the number of patients seen.&lt;br&gt;
For each of your patients you should be aware of gender, race, ethnicity, date of birth, preferred language, and insurance type. You&apos;ll probably need to add fields for &quot;race&quot; and &quot;ethnicity&quot; to supplement the demographics you&apos;re already collecting.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; Record vital signs.&lt;br&gt;
&lt;strong&gt;Measure:&lt;/strong&gt; 80% of patients seen age 2 and over, including ALL data elements. Denominator is total of unique patients age 2 and over seen.&lt;br&gt;
Your system must allow you to record height, weight, and blood pressure, calculate and display BMI, and plot and display growth charts for patients 2 to 20 years old, including BMI. If your system doesn&apos;t calculate BMI, ask your vendor when that will be updated in a release to your software.&lt;/p&gt;

&lt;p&gt;With the specific criteria objectives and measures such as these in hand you can implement the EHR and achieve meaningful use, improved healthcare quality and efficiency in operations.&lt;/p&gt;
&lt;p&gt;It will take work, but it can be done!&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_280"
                     title="Better Overall Diabetes Care Lowers Nephropathy Risk (CME/CE)"
                     score="0.001"
                     href="http://www.medpagetoday.com/Nephrology/Diabetes/tb/18136?impressionId=1265806857007"
                     
      &lt;p&gt;Simultaneously achieving tight glucose control and other targets in diabetes reduces the risk of kidney complications, researchers found.&lt;/p&gt;
&lt;p&gt;An aggressive multifactorial intervention appeared to delay diabetic nephropathy better when more targets were achieved (&lt;em&gt;P&lt;/em&gt;=0.002 for trend) in a longitudinal study of Chinese patients led by Ming-Chia Hsieh, MD, PhD, of Kaohsiung Medical University Hospital in Kaohsiung, Taiwan.&lt;/p&gt;
&lt;p&gt;The risk of new-onset microalbuminaria dropped 27.1% for those who met the American Diabetes Association-recommended goal of less than 7% glycosylated hemoglobin (&lt;em&gt;P&lt;/em&gt;=0.03), the researchers reported in the Jan. 25 &lt;em&gt;Archives of Internal Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Reaching the systolic blood pressure goal of less than 130 mm Hg reduced this risk 35.5% (&lt;em&gt;P&lt;/em&gt;=0.002). Achieving the HDL cholesterol goal  --  over 50 mg/dL for women and 40 mg/dL for men  --  reduced the risk by 28.5% (&lt;em&gt;P&lt;/em&gt;=0.02).&lt;/p&gt;
&lt;p&gt;&quot;The control of microalbuminuria may halt progress to overt nephropathy and reduce occurrence of cardiovascular events in these patients,&quot; Hsieh&apos;s group wrote.&lt;/p&gt;
&lt;p&gt;They suggested that this type of intensive intervention &quot;can be used at the very early stages of diabetic renal disease.&quot;&lt;/p&gt;
&lt;p&gt;Prior studies had suggested that intensive therapy could prevent nephropathy in patients who had already started showing signs of progression.&lt;/p&gt;
&lt;p&gt;So to see if starting earlier would be as effective, Hsieh and colleagues initiated a longitudinal cohort study of 1,290 patients with type 2 diabetes and normoalbuminuria in which participants received intensified treatment to meet ADA-recommended goals on glucose, blood pressure, cholesterol, and triglycerides.&lt;/p&gt;
&lt;p&gt;To this end, patients got the combined efforts of a physician, nurse, and dietitian working together on counseling and patient education to modify behavior.&lt;/p&gt;
&lt;p&gt;By the end of the intervention patients were more likely to have switched from single agent glucose-lowering treatment to insulin plus an oral hypoglycemic agent and to have gone on an antihypertensive (74% versus 48% baseline), statin (58.1% versus 28.0% baseline), and fibrate (14.0% versus 3.0% baseline).&lt;/p&gt;
&lt;p&gt;By the end of the study period, the mean glycosylated hemoglobin was 7.3%, while blood pressure averaged 129.3/74.4 mm Hg. Mean LDL cholesterol was 98.6 mg/dL, triglycerides were at 116.0 mg/dL, and mean HDL cholesterol was 53.6 mg/dL.&lt;/p&gt;
&lt;p&gt;Over the 4.5 years of follow-up, 16.4% of patients developed new-onset microalbuminuria.&lt;/p&gt;
&lt;p&gt;Unlike attainment of HDL cholesterol, glycosylated hemoglobin, and systolic blood pressure goals, reaching those for LDL cholesterol, diastolic blood pressure, and triglycerides appeared to have little impact on kidney function.&lt;/p&gt;
&lt;p&gt;But the more targets patients reached, the less likely they were to develop microalbuminuria (&lt;em&gt;P&lt;/em&gt;=0.002).&lt;/p&gt;
&lt;p&gt;The majority of participants in the study reached one or two of the treatment targets (71.4%) and 8.1% achieved three.&lt;/p&gt;
&lt;p&gt;Those who did reach two or three of the goals were at significantly lower risk of new-onset microalbuminuria than the 20.5% who didn&apos;t reach any of the goals (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Those who reached one target tended to be at lower risk as well, but the effect was not significant compared with reaching none of the goals (&lt;em&gt;P&lt;/em&gt;=0.35).&lt;/p&gt;
&lt;p&gt;One of the concerns with the tight glucose control goal has been hypoglycemia. In the study, 217 patients had at least one episode. Four cases involved major hypoglycemia, though without clinical morbidity or mortality.&lt;/p&gt;
&lt;p&gt;Overall, 37 patients died from any cause during the study period.&lt;/p&gt;
&lt;p&gt;A &lt;a href=&quot;http://www.medpagetoday.com/Cardiology/Diabetes/13818&quot; mce_href=&quot;http://www.medpagetoday.com/Cardiology/Diabetes/13818&quot; target=&quot;_blank&quot;&gt;review&lt;/a&gt; of recent large trials of aggressive glycemic control  --  U.K. Prospective Diabetes Study (UKPDS) and the U.S.-based ACCORD, ADVANCE, and VA Diabetes trials  --  suggested a two- to threefold increased risk of severe hypoglycemia without macrovascular benefits.&lt;/p&gt;
&lt;p&gt;In the recent &lt;a href=&quot;http://www.medpagetoday.com/Cardiology/Diabetes/9739&quot; mce_href=&quot;http://www.medpagetoday.com/Cardiology/Diabetes/9739&quot; target=&quot;_blank&quot;&gt;ACCORD&lt;/a&gt; trial, tight glucose control that brought hemoglobin A1c close to 6%, with a target of less than the standard 7.0%, resulted in 22% excess mortality risk.&lt;/p&gt;
&lt;p&gt;The search for a reason behind this risk has yet to turn up a culprit. &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/ADA/14635&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/ADA/14635&quot; target=&quot;_blank&quot;&gt;Analyses&lt;/a&gt; have suggested that hypoglycemia isn&apos;t to blame and that the lower A1c levels themselves aren&apos;t a problem.&lt;/p&gt;
&lt;p&gt;In the wake of the negative findings from ACCORD, ADVANCE, and the VA trials, leading diabetologists had suggested that pushing too hard in people who couldn&apos;t reach the targets might have been at fault.&lt;/p&gt;
&lt;p&gt;Rather than a one-size-fits all approach, the ADA guidelines suggest individualizing treatment targets.&lt;/p&gt;
&lt;p&gt;Hsieh&apos;s group acknowledged that &quot;even with close attention, not all our patients could achieve the ADA-recommended goals,&quot; but re-emphasized that for patients who could achieve targets, there were benefits.&lt;/p&gt;
&lt;p&gt;The researchers cautioned that their study was limited by lack of a comparison group, no data on genetic factors, and use of potentially arbitrary treatment target cutoff points.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_681"
                     title="Failing Kidney Drives Stroke Risk in Atrial Fibrillation"
                     score="-0.006"
                     href="http://www.medpagetoday.com/CriticalCare/Strokes/tb/13146?impressionId=1265806857007"
                     
      OAKLAND, Calif., March 5 -- Proteinuria on top of atrial fibrillation increases stroke risk by more than 50%, and that risk also increases steadily as kidney function declines, researchers said.
              &lt;p&gt; 
              &lt;p&gt;By itself, atrial fibrillation is a major risk factor for stroke, but when atrial fibrillation patients begin spilling protein into urine, the risk of thromboembolism climbs to 1.54 (95% confidence interval 1.29 to 1.85) after adjustment for known stroke risk factors (prior stroke, age, hypertension, diabetes, and heart failure) and other confounders, said Alan S. Go, M.D., of the division of research at Kaiser Permanente of Northern California.
              &lt;p&gt; 
              &lt;p&gt;They reported their findings in the March 17 issue of &lt;em&gt;Circulation, Journal of the American Heart Association.&lt;/em&gt;
              &lt;p&gt;
              &lt;p&gt;The link between atrial fibrillation and chronic kidney disease emerged from the ATRIA (Assembly of the Anticoagulation and Risk Factors in Atrial Fibrillation) cohort study of 13,535 adults with nonvalvular atrial fibrillation and no prior kidney transplant.
              &lt;p&gt; 
              &lt;p&gt;During follow-up off anticoagulation therapy involving more than 10,000 patients, there were 676 documented ischemic events, including 637 ischemic strokes. 
              &lt;p&gt; 
              &lt;p&gt;&quot;The rate of thromboembolism off warfarin increased significantly with lower eGFR,&quot; Dr. Go wrote. Moreover, the event rate was &quot;higher with documented proteinuria at every level of estimated glomerular filtration rate.&quot;
              &lt;p&gt; 
              &lt;p&gt;Dr. Go and colleagues concluded that clinicians &quot;should consider ascertaining information about the level of estimated glomerular filtration rate and the presence of proteinuria in patients with atrial fibrillation, which may improve the risk stratification for decision-making about the use of antithrombotic therapy for stroke prevention.&quot;
              &lt;p&gt; 
              &lt;p&gt;The mean age of patients in the study was 71.6, and 42.8% were women. The patients were treated for atrial fibrillation from July 1, 1996 though December 31, 1997, with follow-up through September 30, 2003.
              &lt;p&gt; 
              &lt;p&gt;At baseline, 7,690 patients had estimated glomerular filtration rates of 60 mL or higher, 2,499 had reduced rates -- defined as 45 to 59 mL -- and 1,338 had rates lower than 45 mL. 
              &lt;p&gt; 
              &lt;p&gt;Among patients with normal creatinine clearance, 697 (9.1%) had documented proteinuria, as did 382 (15.3%) of those with estimated glomerular filtration rates in the 45 to 59 mL range and 333 (24.9%) of those with rates lower than 45 mL.
              &lt;p&gt; 
              &lt;p&gt;There was a graded, increased risk of thromboembolism associated with a lower level of estimated glomerular filtration rate. Compared with a glomerular filtration rate of 60 mL per min per 1.73 m&lt;sup&gt;2&lt;/sup&gt;, the adjusted relative risk for thromboembolism was 1.16 (95% CI, 0.95 to 1.40) for eGFR 45 to 59 mL and 1.39 (95% CI, 1.13 to 1.71) for eGFR &lt;45 (&lt;em&gt;P&lt;/em&gt;&lt;0.0082 for trend).
              &lt;p&gt; 
              &lt;p&gt;Dr. Go conceded that the stroke rate among ESRD patients is &quot;high overall, and risk factors for stroke such as hypertension, diabetes mellitus, coronary artery disease, and heart failure are common.&quot;
              &lt;p&gt; 
              &lt;p&gt;But less was known about stroke risk in patients who had not yet progressed to kidney replacement therapy and who have their condition complicated by atrial fibrillation. 
              &lt;p&gt; 
              &lt;p&gt;&quot;Thus our study provides novel insights in demonstrating that the presence and severity of [chronic kidney disease] (as reflected by eGFR and proteinuria) are associated with a higher risk of ischemic stroke and other thromboembolism in patients with [atrial fibrillation] independently of known risk factors for stroke in [atrial fibrillation],&quot; Dr. Go said.
              &lt;p&gt; 
              &lt;p&gt;He noted that the study was limited by a small number of patients for whom baseline kidney function was not known. Additionally, he and his colleagues were not able to characterize the type of ischemic stroke, although &quot;the majority of strokes in the setting of [atrial fibrillation] are cardioembolic.&quot;
              &lt;p&gt; 
              &lt;p&gt;Also, researchers used the Modification of Diet in Renal Disease equation to estimate glomerular filtration rate, an approach that has not been validated in nonblack ethnic minorities. As a result, Dr. Go said, &quot;misclassification may be present in such patients in our study sample.&quot;
              &lt;p&gt; 
              &lt;p&gt;Finally, the study was conducted in Northern California in a population that is considered representative of insured adults in that region, but may not be representative of the nation as a whole.
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; The study was funded by a Public Health Services research grant from the National Institute on Aging and by the Edith and Eliot Shoolman Fund of the Massachusetts General Hospital.
              &lt;p&gt; 
              &lt;p&gt;Dr. Go disclosed research grants from the National Institute on Aging, and the National Heart, Lung, and Blood Institute. &lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_2346"
                     title="Protein May Point to HIV Kidney Disease"
                     score="-0.006"
                     href="http://www.medpagetoday.com/InfectiousDisease/HIVAIDS/tb/15236?impressionId=1265806857007"
                     
       HOUSTON, July 24 -- Patients with HIV-associated nephropathy have elevated urinary levels of a protein associated with tubular injury, suggesting the marker has potential as a test for early diagnosis, investigators reported. 
              &lt;p&gt;
              &lt;p&gt;A mouse model of HIV-associated nephropathy revealed upregulation of neutrophil gelatinase-associated lipocalin (NGAL), providing additional evidence of the protein&apos;s diagnostic potential, Jonathan Barasch, MD, PhD, and colleagues reported online in the &lt;em&gt;Journal of the American Society of Nephrology&lt;/em&gt;. 
              &lt;p&gt;
              &lt;p&gt;&quot;NGAL was very specifically expressed in renal cysts -- generating the new idea that NGAL may control the development of cysts in HIV-associated nephropathy,&quot; Dr. Barasch, of Columbia University in New York, said in a statement.
              &lt;p&gt; 
              &lt;p&gt;Since the discovery of NGAL in the kidney 10 years ago, &quot;almost every paper is positive for the association of NGAL with kidney dysfunction/disease,&quot; he added. (See &lt;a href=&quot;http://www.medpagetoday.com/CriticalCare/GeneralCriticalCare/15223&quot; target=&quot;blank&quot;&gt;Urine Test Predicts Kidney Injury in ICU Patients&lt;/a&gt;) 
              &lt;p&gt;
              &lt;p&gt;Occurring predominantly in patients of African descent, HIV-associated nephropathy is characterized by nephrosis and rapid decline in kidney function. Histologically, the condition is a collapsing focal segmental glomerulosclerosis with prominent tubular damage. 
              &lt;p&gt;
              &lt;p&gt;NGAL&apos;s association with tubular injury provided a rationale for evaluating urinary levels of the protein as a marker of HIV-associated nephropathy. 
              &lt;p&gt;
              &lt;p&gt;Investigators studied 13 patients with biopsy-proven HIV-associated nephropathy and 24 race-matched HIV patients with normal kidney function, defined as an estimated glomerular filtration rate e60 ml/min and no evidence of proteinuria.
              &lt;p&gt; 
              &lt;p&gt;The patients with HIV-associated nephropathy also were compared with other HIV-positive and HIV-negative patients with other types of chronic kidney disease. 
              &lt;p&gt;
              &lt;p&gt;To obtain additional information about NGAL and HIV-associated nephropathy, investigators studied HIV-transgenic mice, which exhibit a syndrome identical to HIV nephropathy. 
              &lt;p&gt;
              &lt;p&gt;The patients with HIV-associated nephropathy had a mean urinary NGAL of 748 �g/g creatinine, which turned out to be: 
         &lt;ul&gt;     &lt;li&gt;     11 times greater than the 68 �g/g creatinine mean in HIV-positive controls without kidney disease (&lt;em&gt;P&lt;/em&gt;=0.006)
              &lt;li&gt;     Five times greater compared with HIV-positive patients who had other types of kidney disease (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05)
              &lt;li&gt;     34 times greater compared with HIV-negative patients with various types of chronic kidney disease (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05) 
              &lt;/ul&gt;&lt;p&gt;In the transgenic mice, urinary NGAL was expressed most prominently in dilated microcystic tubules. Investigators detected NGAL RNA in 39% of 2,698 microcysts but not in any noncystic tubules. 
              &lt;p&gt;
              &lt;p&gt;&quot;These data suggest the possibility that urinary NGAL may be useful to monitor the formation of renal tubular cysts and consequently distinguish HIV-associated nephropathy from common forms of chronic kidney disease . . . presenting in the HIV patient,&quot; the authors said. 
              &lt;p&gt;
              &lt;p&gt;&quot;In this light,&quot; they said, &quot;the very high levels of urinary NGAL associated with HIV-associated nephropathy may provide a rationale for biopsy and aggressive HAART therapy to prevent progression of HIV-associated nephropathy to end-stage renal disease.&quot; 
              &lt;p&gt;
              &lt;p&gt;The authors acknowledge, though, that more research is needed, especially &quot;in a large cohort where we can determine the temporal relationships between NGAL expression and disease onset and between NGAL expression and HAART.&quot; 
              &lt;p&gt;
             &lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The authors disclosed that Columbia University and Cincinnati Children&apos;s Hospital Medical Center (institution of one coauthor) have received licensing fees from Biosite and Abbott Diagnostics. 
       &lt;/td&gt;&lt;/tr&gt;&lt;/table&gt; &lt;p&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_243"
                     title="Kidney Failure Another Potential Health Risk of Obesity"
                     score="-0.007"
                     href="