#EB2012 #Navar: Reflections on the Work of a Lifetime

Apr 23 2012 Published by under EB2012 Meeting, [Biology&Environment]

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Dr. Navar and his entourage, pre-lecture

The final official event of Saturday actually provided the official opening of the meeting for the American Physiological Society (APS). Current president Joey Granger walked us through 125 years of the APS, including the founding of the umbrella organization FASEB (Federation of American Societies for Experimental Biology) 100 years ago. He then introduced the speaker, Gabby Navar, who presented his lifetime of work in renal physiology and the role of the kidney in hypertension (click here for more background).

Science takes place in baby-steps. Even a paper in a glamour journal with years of data, like a toddler's first efforts, is just as likely to lead to falling back on a full diaper as a movement forward. Take enough of these steps, and you can eventually get somewhere. You may always risk a trip and a fall, but with time you move forward.

Dr. Navar's contributions to science brought to mind two major observations. First, hypertension is not a disease. A disease has a cause and an effect. While the effect may be a single physiological measurement such as blood pressure, its causes clearly involve multiple genes and environmental factors. We should think of it as a syndrome.

Syndrome generally means a cluster of symptoms; the origins of the word signify concurrence. For example, a microangiopathic hemolytic anemia with kidney damage leads to a diagnosis of hemolytic uremic syndrome. This syndrome may be the result of several known diseases as well as some not yet characterized. I propose that hypertension, while not a cluster of abnormalities, is a syndrome in  a similar sense. Multiple diseases, defined and not, can cause high blood pressure as their sole manifestation.

The other point I considered overnight was how essential animal research has been in our advances in hypertension. We simply would not be able to tease out the complex relationships between neural, renal, and other mechanisms in blood pressure control without the use of animals.

Congratulations to Gabby Navar for a great talk and a good start to a great meeting.

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Rhythm of Life

Dec 02 2011 Published by under [Medicine&Pharma]

Check out my Guest Post over at Scientific American today: Dipping with the Stars.

If the video player doesn't show above, click here for a real visual treat.
Sadly, I'm not talking about that sort of dipping or those sorts of stars. No, this post discusses what your blood pressure does when you sleep at night while the stars shine in the sky.

Enjoy your weekend!

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Taking Slow, Deliberate Baby Steps

Nov 03 2011 Published by under [Information&Communication], [Medicine&Pharma]

I cannot understand why biomedical jounals (with rare exceptions) do not have places online for discussion of articles. How many people actually get their act together to write a formal letter to the editor, especially when that sort of publication counts for next to nothing on your CV?

In contrast, a lively discussion can occur in the blogosphere if you do not place too many barriers to participation.

I think the American Society of Nephrology finally gets it!

In the last couple of weeks they quietly rolled out an interactive blog with Disqus sign-in for comments. Yesterday the ASN overlords tweeted about the site, so it's now fair game for me to blog. Yes, the ASN tweets; over the past year they have established an active social media presence in a number of venues.

Normotensive Dipper (Click to Enlarge)

Hypertensive NonDipper (Click to Enlarge)

Now they've built it, and we should click! The latest post regards a study showing that bedtime administration of blood pressure medications in chronic kidney disease patients significantly reduces the risk of stroke and cardiovascular events. Why should that be? Well, normal people have an overnight "dip" in blood pressure while they sleep (upper image at left). Even patients with hypertension may retain a "dip" and have a better prognosis than patients who lose the dip. Many hypertensive patients lose their "dip" (lower image), sometimes even before their daytime blood pressures become elevated!

Overnight level of hypertension and lack of "dip" indicates greater cardiovascular risk than daytime blood pressure levels. Giving at least one dose of antihypertensive therapy at bedtime can lower overnight blood pressure and restore a more normal physiological (dare I say circadian?) pattern.

So click over and help get some chat going on the site if you care about kidneys and related science and policy. It's also an example of how mainstream journals can open up for discussion without the risk that their official site will get cluttered with spam and trolls.

Keep this effort in mind for ScienceOnline2012. On Saturday at noon I will facilitate (at an un-conference do I un-facilitate or obstruct?) the discussion on the resistance of journals and media to blogging and online post-publication review of the scientific record. See you in North Carolina!

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Kidney Stuff: Follow the Links

Aug 10 2010 Published by under [Medicine&Pharma]

What's up with this?

If you have any interest in kidneys and kidney disease, you need to be reading the Renal Fellow Network Blog. I link to it in my blogroll in the right-hand column (aren't you paying attention?).

These fellows (fellow, in this case, not being a gender-specific term) find interesting tidbits, trends, and other factoids to blog from the world of nephrology. The August 5 post featured the abdominal film shown, with lots and lots of stuff in the gut- stuff denser than the patient's bones. What on earth could it be? Click on over and see!

I also blogged today at my PG-rated blog about a pediatric disorder with a kidney component that can be mistaken for a fatal disease. What could it be? Sorry- you have to click through to see.

Another nephro-blogger posted this week about a web-based blood pressure tracker and posts a video demonstration. Blood Pressure Chart will also send you email reminders for Bp monitoring, and you can send all your data to your health care provider easily. You can also link the charts to your facebook and twitter accounts; I'm guessing this is more than my followers want to know. But, perhaps, social media can provide some peer pressure and support to get folks to adhere to their medical treatments.

So click the links and enjoy some random kidney updates. Because urine is golden!

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