Kidney Disease and Heart Disease Spur Each Other

    Hearts and kidneys： If one"s diseased, better keep a close eye on¹ the other. Surprising new research shows kidney disease somehow speeds up heart disease well before it has ravaged the kidneys. And perhaps not so surprising, doctors have finally proven that heart disease can trigger kidney destruction, too.

    The work，from two studies involving over 50,000 patients, promises to boost efforts to diagnose simmering kidney disease earlier. All it takes are urine and blood tests that cost less than $25, something proponents want to become as routine as cholesterol checks.²"The average patient knows their cholesterol，’ says Dr. Peter McCuilough, preventive medicine chief at Michigan"sWilliamBeaumontHospital. "The average patient has no idea of³ their kidney function. ”

    Chronic kidney disease，or CKD，is a quiet epidemic ： Many of the 19 million Americans estimated to have it don"t know they do. The kidneys lose their ability to filter waste out of the bloodstream so slowly that symptoms aren"t obvious until the organs are very damaged.⁴ End-stage kidney failure is rising fast, with 400,000 people requiring dialysis or a transplant to survive, a toll that has doubled in each of the last two decades.⁵

    And while CKD patients often are terrified of having to go on dialysis，the hard truth is that most will die of heart disease before their kidneys disintegrate to that point, something kidney specialists have recognized for several years but isn"t widely known.⁶ Indeed, the new research is highlighted in this month"s Archives of Internal Medicine with a call for doctors who care for heart patients to start rigorously checking out the kidneys，and for better care of early kidney disease.⁷

    The link sounds logical. After all⁸，high blood pressure and diabetes are chief risk factors for both chronic kidney disease and heart attacks. But the link goes beyond⁹ those risk factors，stresses McCuilough：Once the kidneys begin to fail, something in turn¹⁰ accelerates heart disease, not just in the obviously sick or very old, but at what he calls "a shockingly early age. ” McCuilough and colleagues tracked more than 37,000 relatively young people 一 average age 53 — who volunteered for a kidney screening. Three markers of kidney function were checked ： The rate at which kidneys filter blood, called the GFR or glomerular filtration rate¹¹；levels of the protein albumin in the urine； and if they were anemic. They also were asked about previously diagnosed heart disease.

    The odds of having heart disease rose steadily as each of the kidney markers worsened. More striking was the death data. At this age，few deaths are expected，and indeed just 191 people died during the study period. But those who had both CKD and known heart disease had a threefold increased risk of death in a mere 2½ years, mostly from heart problems. "This study is very much a wake-up call," McCullough says.

词汇：

kidney 肾 spur 刺激 ravage .蹂躏；破坏；毁掉

trigger 激发，引起 destruction .破坏；毁灭

simmer(用小火）慢慢地煮(炖）；（感情等）即将爆发

proponent 提议者；支持者 cholesterol 胆固醇

epidemic.流行"性的；n.流行病；（流行病）流行

filter过滤，滤过,滤清 bloodstream .血、流

dialysis 透析 transplant移植；n.移植；移植物

toll 代价;损失；（事故等）伤亡人数

terrify .吓倒，吓坏 disintegrate 瓦解；蜕变

highlight 使突出，使注意 archive (常用复数）档案；档案室

rigorously 严格地 diabetes 糖尿病，多尿症

shockingly 极度地，极端地 marker标示物

albumin .清蛋白，白蛋白 anemic贫血的 odds(单复数同形）可能性，机会　　

kidney / ˈkɪdni / n.  肾

spur  /spɜ:n/ vt. 刺激

ravage  /"rævɪdʒ / vt.  .蹂躏；破坏；毁掉

trigger / ˈtrɪgə(r)/ n.   激发，引起

destruction / dɪ"strʌkʃn)/ n.破坏；毁灭

simmer(用小火）  /"sɪmə(r)/ vt. 慢慢地煮(炖）；（感情等）即将爆发

proponent / prəˈpəʊnənt / n. 提议者；支持者

cholesterol / kəˈlestərɒl / n. 胆固醇

epidemi / ˌepɪ"demɪk/ adj.流行"性的；n.流行病；（流行病）流行

filter  /ˈfɪltə(r)/ vi.过滤，滤过,滤清

bloodstream /ˈblʌdstri:m/ n.血、流

dialysis /ˌdaɪˈæləsɪs/ n.透析

transplant / trænsˈplɑ:nt/ vt.  移植；n.移植；移植物

toll /təʊl/ n. 代价;损失；（事故等）伤亡人数

terrify / ˈterɪfaɪ/ vt.吓倒，吓坏

disintegrate / dɪs"ɪntɪɡreɪt/ vt. 瓦解；蜕变

highlight / ˈhaɪlaɪt/ vt. 使突出，使注意

archive /"ɑ:kaɪv/ n. (常用复数）档案；档案室

rigorously  /"rɪɡərəslɪ/ adv. 严格地

diabetes /ˌdaɪəˈbi:ti:z/ n. 糖尿病，多尿症

shockingly /"ʃɒkɪŋlɪ/ adv. 极度地，极端地

marker/ˈmɑ:kə(r)/ n.标示物

albumin /æl"bju:mɪn/ n.清蛋白，白蛋白

anemic /ə"ni:mɪk/ adj.贫血的

odds /ɒdz/ n. (单复数同形）可能性，机会

注释：

1.keep a close eye on:密切地关注

2. All it takes are urine and blood tests that cost less than $25，something proponents want to become as routine as cholesterol checks.这种对缓慢形成的肾病的早期诊断所采取的全部措 施就是尿检和血检，其费用不足25美元，提出这项建议的人希望它能像胆固醇检查那样成 为一种常规检查。本句中，it takes是all的定语从句，something是urine and blood tests的 同位语，proponents want to become as routine as cholesterol checks 是 something 的金语从句。

3.have no idea of:没有……的概念,不知道……

4.The kidneys lose their ability to filter waste out of the bloodstream so slowly that symptoms aren"t obvious until the organs are very damaged.肾脏如此缓慢地丧失它从i流中—出废物 的能力，以至于直到该器官受到严重损伤时才有明显症状。not... until:直到……才……。

5.End-stage kidney failure is rising fast, with 400,000 people requiring dialysis or a transplant to survive, a toll that has doubled in each of the last two decades.终末期丨肾衰竭病人数目迅速 增加，有40万人需要肾透析或肾移^[才能存话，这个数字在近20年中每10年翻一番。 end-stage kidney failure??终末期肾衰竭。a toll 是 400,000 people requiring dialysis or a transplant to survive 的同位语。

6.And while CKD patients often are terrified of having to go on dialysis, the hard truth is that most will die of heart disease before their kidneys disintegrate to that point, something kidney specialists have recognized for several years but isn"t widely known.尽管慢性肾病患者常常 害怕不得不去做肾透析，但是严酷的事实是，大多数人在肾脏还没有那么糟糕以前就死于 心脏病，这一点肾病专家几年前就已经知道，只是不被广为人知而已。这里，something是the hard truth is... to that point 这个句子的同位语，后面的 kidney specialists have recognized for several years but isn"t widely known 则是 something 的定语从句，省略了关系代词 that。

7.Indeed, the new research is highlighted in this month"s Archives of Internal Medicine with a call for doctors who care for heart patients to start rigorously checking out the kidneys，and for better care of early kidney disease.其实，这项新的研究在本月的《内科档案》杂志上就受到重视，该研 究号召为心脏病人治病的医生要开始严格地检查病人的肾脏，并要更好地关注早期肾病。Archives of Internal Medicine：《内科档案》。call for：要求，号召，提倡。check out:检验。

8.after all:毕竟

9.go beyond:超过

10in turn:依次

11glomerular filtration rate (GFR)：肾小球滤过率

What did the Archives of Internal Medicine call for doctors caring for heart patients to do?

A:To examine their patients" heart function carefully B:To have their patients" chests X-rayed regularly C:To select volunteers from their patients for a kidney screening D:To start rigorously checking out their patients" kidneys

The Supreme Court’’ s decisions on physician-assisted suicide carry important implications for how medicine seeks to relieve dying patients of pain and suffering. Although it ruled that there is no constitutional right to physician-assisted suicide, the Court in effect supported the medical principle of "double effect," a centuries-old moral principle holding that an action having two effects―a good one that is intended and a harmful one that is foreseen―is permissible if the actor intends only the good effect. Doctors have used that principle in recent years to justify using high doses of morphine to control terminally iii patients’’ pain, even though increasing dosages will eventually kill the patient. Nancy Dubler, director of Montefiore Medical Center, contends that the principle will shield doctors who" until now have very, very strongly insisted that they could not give patients sufficient medication to control their pain if that might hasten death." George Annas, chair of the health law department at Boston University, maintains that, as long as a doctor prescribes a drug for a legitimate medical purpose, the doctor has done nothing illegal even if the patient uses the drug to hasten death. "It’’s like surgery," he says." We don’’t call those deaths homicides because the doctors didn’’t intend to kill their patients, although they risked their death. If you’’re a physician, you can risk your patients’’ suicide as long as you don’’t intend their suicide." On another level, many in the medical community acknowledge that the assisted-suicide debate has been fueled in part by the despair of patients for whom modern medicine has prolonged the physical agony of dying. Just three weeks before the Court’’s ruling on physician-assisted suicide, the National Academy of Science (NAS) released a two-volume report, Approaching Death: Improving Care at the End of Life. It identifies the undertreatment of pain and the aggressive use of" ineffectual and forced medical procedures that may prolong and even dishonor the period of dying" as the twin problems of end-of-life care. The profession is taking steps to require young doctors to train in hospices, to test knowledge of aggressive pain management therapies, to develop a Medicare billing code for hospital-based care, and to develop new standards for assessing and treating pain at the end of life. Annas says lawyers can play a key role in insisting that these well-meaning medical initiatives translate into better care." Large numbers of physicians seem unconcerned with the pain their patients are needlessly and predictably suffering," to the extent that it constitutes" systematic patient abuse." He says medical licensing boards" must make it clear.., that painful deaths are presumptively ones that are incompetently managed and should result in license suspension." George Annas would probably agree that doctors should be punished if they

A:manage their patients incompetently. B:give patients more medicine than needed. C:reduce drug dosages for their patients. D:prolong the needless suffering of the patients.

The Supreme Court’’ s decisions on physician-assisted suicide carry important implications for how medicine seeks to relieve dying patients of pain and suffering. Although it ruled that there is no constitutional right to physician-assisted suicide, the Court in effect supported the medical principle of "double effect," a centuries-old moral principle holding that an action having two effects―a good one that is intended and a harmful one that is foreseen―is permissible if the actor intends only the good effect. Doctors have used that principle in recent years to justify using high doses of morphine to control terminally iii patients’’ pain, even though increasing dosages will eventually kill the patient. Nancy Dubler, director of Montefiore Medical Center, contends that the principle will shield doctors who" until now have very, very strongly insisted that they could not give patients sufficient medication to control their pain if that might hasten death." George Annas, chair of the health law department at Boston University, maintains that, as long as a doctor prescribes a drug for a legitimate medical purpose, the doctor has done nothing illegal even if the patient uses the drug to hasten death. "It’’s like surgery," he says." We don’’t call those deaths homicides because the doctors didn’’t intend to kill their patients, although they risked their death. If you’’re a physician, you can risk your patients’’ suicide as long as you don’’t intend their suicide." On another level, many in the medical community acknowledge that the assisted-suicide debate has been fueled in part by the despair of patients for whom modern medicine has prolonged the physical agony of dying. Just three weeks before the Court’’s ruling on physician-assisted suicide, the National Academy of Science (NAS) released a two-volume report, Approaching Death: Improving Care at the End of Life. It identifies the undertreatment of pain and the aggressive use of" ineffectual and forced medical procedures that may prolong and even dishonor the period of dying" as the twin problems of end-of-life care. The profession is taking steps to require young doctors to train in hospices, to test knowledge of aggressive pain management therapies, to develop a Medicare billing code for hospital-based care, and to develop new standards for assessing and treating pain at the end of life. Annas says lawyers can play a key role in insisting that these well-meaning medical initiatives translate into better care." Large numbers of physicians seem unconcerned with the pain their patients are needlessly and predictably suffering," to the extent that it constitutes" systematic patient abuse." He says medical licensing boards" must make it clear.., that painful deaths are presumptively ones that are incompetently managed and should result in license suspension." George Annas would probably agree that doctors should be punished if they

A:manage their patients incompetently. B:give patients more medicine than needed. C:reduce drug dosages for their patients. D:prolong the needless suffering of the patients.

The Supreme Court’’ s decisions on physician-assisted suicide carry important implications for how medicine seeks to relieve dying patients of pain and suffering. Although it ruled that there is no constitutional right to physician-assisted suicide, the Court in effect supported the medical principle of "double effect," a centuries-old moral principle holding that an action having two effects―a good one that is intended and a harmful one that is foreseen―is permissible if the actor intends only the good effect. Doctors have used that principle in recent years to justify using high doses of morphine to control terminally iii patients’’ pain, even though increasing dosages will eventually kill the patient. Nancy Dubler, director of Montefiore Medical Center, contends that the principle will shield doctors who" until now have very, very strongly insisted that they could not give patients sufficient medication to control their pain if that might hasten death." George Annas, chair of the health law department at Boston University, maintains that, as long as a doctor prescribes a drug for a legitimate medical purpose, the doctor has done nothing illegal even if the patient uses the drug to hasten death. "It’’s like surgery," he says." We don’’t call those deaths homicides because the doctors didn’’t intend to kill their patients, although they risked their death. If you’’re a physician, you can risk your patients’’ suicide as long as you don’’t intend their suicide." On another level, many in the medical community acknowledge that the assisted-suicide debate has been fueled in part by the despair of patients for whom modern medicine has prolonged the physical agony of dying. Just three weeks before the Court’’s ruling on physician-assisted suicide, the National Academy of Science (NAS) released a two-volume report, Approaching Death: Improving Care at the End of Life. It identifies the undertreatment of pain and the aggressive use of" ineffectual and forced medical procedures that may prolong and even dishonor the period of dying" as the twin problems of end-of-life care. The profession is taking steps to require young doctors to train in hospices, to test knowledge of aggressive pain management therapies, to develop a Medicare billing code for hospital-based care, and to develop new standards for assessing and treating pain at the end of life. Annas says lawyers can play a key role in insisting that these well-meaning medical initiatives translate into better care." Large numbers of physicians seem unconcerned with the pain their patients are needlessly and predictably suffering," to the extent that it constitutes" systematic patient abuse." He says medical licensing boards" must make it clear.., that painful deaths are presumptively ones that are incompetently managed and should result in license suspension." George Annas would probably agree that doctors should be punished if they

A:manage their patients incompetently. B:give patients more medicine than needed. C:reduce drug dosages for their patients. D:prolong the needless suffering of the patients.

The Supreme Court’’ s decisions on physician-assisted suicide carry important implications for how medicine seeks to relieve dying patients of pain and suffering. Although it ruled that there is no constitutional right to physician-assisted suicide, the Court in effect supported the medical principle of "double effect," a centuries-old moral principle holding that an action having two effects―a good one that is intended and a harmful one that is foreseen―is permissible if the actor intends only the good effect. Doctors have used that principle in recent years to justify using high doses of morphine to control terminally iii patients’’ pain, even though increasing dosages will eventually kill the patient. Nancy Dubler, director of Montefiore Medical Center, contends that the principle will shield doctors who" until now have very, very strongly insisted that they could not give patients sufficient medication to control their pain if that might hasten death." George Annas, chair of the health law department at Boston University, maintains that, as long as a doctor prescribes a drug for a legitimate medical purpose, the doctor has done nothing illegal even if the patient uses the drug to hasten death. "It’’s like surgery," he says." We don’’t call those deaths homicides because the doctors didn’’t intend to kill their patients, although they risked their death. If you’’re a physician, you can risk your patients’’ suicide as long as you don’’t intend their suicide." On another level, many in the medical community acknowledge that the assisted-suicide debate has been fueled in part by the despair of patients for whom modern medicine has prolonged the physical agony of dying. Just three weeks before the Court’’s ruling on physician-assisted suicide, the National Academy of Science (NAS) released a two-volume report, Approaching Death: Improving Care at the End of Life. It identifies the undertreatment of pain and the aggressive use of" ineffectual and forced medical procedures that may prolong and even dishonor the period of dying" as the twin problems of end-of-life care. The profession is taking steps to require young doctors to train in hospices, to test knowledge of aggressive pain management therapies, to develop a Medicare billing code for hospital-based care, and to develop new standards for assessing and treating pain at the end of life. Annas says lawyers can play a key role in insisting that these well-meaning medical initiatives translate into better care." Large numbers of physicians seem unconcerned with the pain their patients are needlessly and predictably suffering," to the extent that it constitutes" systematic patient abuse." He says medical licensing boards" must make it clear.., that painful deaths are presumptively ones that are incompetently managed and should result in license suspension." George Annas would probably agree that doctors should be punished if they

A:manage their patients incompetently. B:give patients more medicine than needed. C:reduce drug dosages for their patients. D:prolong the needless suffering of the patients.

According to the passage, why were doctors in the West sometimes unable to help their patients ( )

A:They did not know how to treat the unfamiliar illnesses. B:They were more interested in establishing practices in the cities. C:They were more concerned with doing research than with treating patients. D:They were often overcome by diseases caught from their patients.