Peter D Hart

Publications of Peter D Hart

• Stem cells from foreign body granulation tissue accelerate recovery from acute kidney injury.

  Authors: Jilpa Patel, Nishit Pancholi, Krishnamurthy P Gudehithlu, Perianna Sethupathi, Peter D Hart, George Dunea, Jose A L Arruda, Ashok K Singh

  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 10/2011;

  BACKGROUND: In previous studies, we obtained mesenchymal stem cells called granulation tissue stem cells (GTSC) from a regenerating granulation tissue created by placing a foreign body in theBACKGROUND: In previous studies, we obtained mesenchymal stem cells called granulation tissue stem cells (GTSC) from a regenerating granulation tissue created by placing a foreign body in the subcutaneous tissue of rats. Here, we used GTSC to ameliorate ischemia/reperfusion-induced acute kidney injury (AKI) in rats.METHODS: In two groups of Fischer rats, we induced ischemia/reperfusion injury. Group 1 (treated rats) received one intravenous injection of GTSC 3 h after injury; Group 2 (control rats) received vehicle. Both groups were subsequently studied by renal function tests, kidney histology and immunohistochemistry.RESULTS: At 24 and 48 h after injury, plasma creatinine and blood urea nitrogen were significantly lower in the treated rats as compared to control rats. The levels remained low and declined to near baseline levels by Day 4 in the treated group. At the cortico-medullary region, the treated rats showed significantly higher renal tubular cell proliferation and less tubular cell apoptosis. Histological analysis of the kidney for tubular dilatation, necrosis, congestion and casts was not significantly different in the two groups. To understand the mechanism of the GTSC effect, messenger RNA levels of several growth and immune modulatory factors were quantified in cultured GTSC and compared with those in cultured glomerular epithelial cell (GEC; a non-stem cell line). GTSC had 2- to 8-fold higher expression of FGF2, HGF, IGF-1, vascular endothelial growth factor (growth factors) and IL-4, IL-6 (anti-inflammatory factors) than GEC.CONCLUSIONS: Administration of GTSC accelerates recovery in rats with ischemia/reperfusion-induced AKI. This effect may be mediated by the paracrine action of growth and immune-suppressive factors secreted by these cells.

• Hypertensive nephropathy: prevention and treatment recommendations.

  Authors: Peter D Hart, George L Bakris

  Expert opinion on pharmacotherapy. 11/2010; 11(16):2675-86.

  A worldwide epidemic of chronic kidney disease (CKD) exists; hypertensive nephropathy is second only to diabetes as a leading cause of progressive CKD. Due to the increasing morbidity and mortalityA worldwide epidemic of chronic kidney disease (CKD) exists; hypertensive nephropathy is second only to diabetes as a leading cause of progressive CKD. Due to the increasing morbidity and mortality and escalating costs associated with end-stage renal disease (ESRD), novel therapeutic strategies are needed urgently to maximally reduce albuminuria, control blood pressure, and delay progression of hypertensive nephropathy to ESRD. In particular, rational use of renin-angiotensin-aldosterone (RAAS) blockers and achieving blood pressure targets are crucial to reduce cardiovascular and renal outcomes. We discuss the pathophysiology of hypertensive nephropathy and review current research evidence in support of i) albuminuria reduction as a key factor to maximally slow CKD progression, ii) the blood pressure (BP) goal of < 130 mmHg, and iii) strategies for prevention and optimal treatment of hypertensive nephropathy. WHAT WILL THE READER GAIN: Insight into the complexity of treating patients with hypertensive nephropathy and the effective strategies required for reducing albuminuria, achieving BP goals and delaying progression of hypertensive nephropathy. Patients with hypertensive proteinuric nephropathy need aggressive BP-lowering with multiple agents that should include RAAS blockers, calcium antagonists and diuretics to maximally slow progression to ESRD.

• Correlates and predictors of physical inactivity among Tennessee adults.

  Authors: Peter D Hart, Tiago V Barreira, Minsoo Kang

  Tennessee medicine : journal of the Tennessee Medical Association. 10/2010; 103(9):41-4.

  The purpose of this study was to investigate the sociodemographic predictors and health-related correlates of no leisure-time physical activity (LTPA) in a representative sample of Tennessee adults.The purpose of this study was to investigate the sociodemographic predictors and health-related correlates of no leisure-time physical activity (LTPA) in a representative sample of Tennessee adults. Data from 5024 adults participating in the 2008 Tennessee Behavioral Risk Factor Surveillance System (BRFSS) were used for the analysis. Overall, 28.9 percent of Tennessee adults (26.2 percent of men and 31.4 percent of women) reported no LTPA. The sociodemographic predictors of no LTPA were age, race, and education. No LTPA was a useful predictor of health status markers such as self-report health, obesity, smoking, and cardiovascular disease. This study found that selected sociodemographic characteristics were adequate predictors of no LTPA among Tennessee adults. Also, the absence of LTPA was found to be a significant predictor of health status.

• Should beta-blockers be used to control hypertension in people with chronic kidney disease?

  Authors: Peter D Hart, George L Bakris

  Seminars in nephrology. 10/2007; 27(5):555-64.

  Activation of the sympathetic nervous system is common in patients with chronic kidney disease, plays an important role in the genesis of hypertension, the rate of decrease of renal function, and isActivation of the sympathetic nervous system is common in patients with chronic kidney disease, plays an important role in the genesis of hypertension, the rate of decrease of renal function, and is associated with the increased cardiovascular morbidity and mortality seen in these patients. beta-blockers are potent antihypertensive agents but differ in their hemodynamic effects on renal function. The cardioselective beta-blockers such as atenolol and metoprolol are known to retard the progression of renal diseases, but to a lesser degree compared with blockers of the renin-angiotensin-aldosterone system. However, the newer vasodilating beta-blockers such as carvedilol and nebivolol have different effects on renal hemodynamics and function primarily because of its greater adjunctive alpha1-blocking activity. Carvedilol decreases renal vascular resistance and prevents reductions in the glomerular filtration rate and renal blood flow in patients with hypertension with or without impaired kidney function. In addition, carvedilol may retard progression of albuminuria, and provide cardiorenal protection in chronic kidney disease patients with hypertension, congestive heart failure, and at high risk for sudden cardiac death.

• Bilateral emphysematous pyelonephritis in a patient with no known risk factors.

  Authors: Peter D Hart, Mohammad Vaseemuddin, Osbert Egiebor, George Dunea

  Journal of the National Medical Association. 03/2007; 99(2):179-81.

  Emphysematous pyelonephritis (EPN) is a rare life-threatening necrotizing infection of the kidney and perirenal space with gas formation. It is usually unilateral and affects patients with a riskEmphysematous pyelonephritis (EPN) is a rare life-threatening necrotizing infection of the kidney and perirenal space with gas formation. It is usually unilateral and affects patients with a risk factor such as diabetes or urinary obstruction. In the past, most patients required nephrectomy, and in bilateral cases long-term dialysis was inevitable. We present here the unusual case of a patient who developed bilateral EPN in the absence of any known risk factor. He was managed conservatively, required dialysis and bilateral nephrostomies, but eventually recovered completely.

• Hypertension control rates: time for translation of guidelines into clinical practice.

  Authors: Peter D Hart, George L Bakris

  The American journal of medicine. 08/2004; 117(1):62-4.