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Contributions to Nephrology

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https://www.readbyqxmd.com/read/27170344/clinical-scenarios-in-chronic-kidney-disease-vascular-chronic-diseases
#1
Mario Meola, Sara Samoni, Ilaria Petrucci
Vascular chronic diseases represent one of the leading causes of end-stage renal disease in incident dialysis patients. B-Mode ultrasound (US) and color Doppler (CD) have a high sensitivity and specificity in the diagnosis of vascular chronic diseases. US and CD should be used to identify subjects in the high risk population who are affected by main renal artery stenosis (RAS) and to identify and characterize patients without RAS who have chronic ischemic nephropathy caused by nephroangiosclerosis and/or atheroembolic disease...
2016: Contributions to Nephrology
https://www.readbyqxmd.com/read/27170301/imaging-in-chronic-kidney-disease
#2
Mario Meola, Sara Samoni, Ilaria Petrucci
Chronic kidney disease (CKD) diagnosis and staging are based on estimated or calculated glomerular filtration rate (GFR), urinalysis and kidney structure at renal imaging techniques. Ultrasound (US) has a key role in evaluating both morphological changes (by means of B-Mode) and patterns of vascularization (by means of color-Doppler and contrast-enhanced US), thus contributing to CKD diagnosis and to the follow-up of its progression. In CKD, conventional US allows measuring longitudinal diameter and cortical thickness and evaluating renal echogenicity and urinary tract status...
2016: Contributions to Nephrology
https://www.readbyqxmd.com/read/27170168/clinical-scenarios-in-acute-kidney-injury-post-renal-acute-kidney-injury
#3
Mario Meola, Sara Samoni, Ilaria Petrucci, Claudio Ronco
The incidence of acute kidney injury related to urinary tract obstruction is low (1-10%). It occurs in bilateral renal or lower urinary tract obstruction or in ureter obstruction in patients with a single functioning kidney or with pre-existing chronic kidney disease. The etiology and the incidence of obstruction vary on the basis of age and gender. Conventional ultrasound has a high sensitivity (>95%), but low specificity (<70%) in the diagnosis of urinary tract obstruction. Nevertheless, color Doppler is used through the evaluation of renal resistive indexes, ureteral jet and twinkling artifact...
2016: Contributions to Nephrology
https://www.readbyqxmd.com/read/27170038/clinical-scenarios-in-acute-kidney-injury-parenchymal-acute-kidney-injury-vascular-diseases
#4
Mario Meola, Sara Samoni, Ilaria Petrucci, Claudio Ronco
Acute cortical necrosis and hemolytic uremic syndrome (HUS) are 2 clinical scenarios of parenchymal acute kidney injury (AKI) related to renal microvascular injury. Acute cortical necrosis is a rare condition related to an ischemic necrosis of renal cortex. Necrotic lesions can be due to several injuries and may be focal, multifocal or diffuse. Renal necrotic lesions become visible with ultrasound only after renal recovery. HUS is a rare disease characterized by hemolytic anemia, thrombocytopenia and AKI. Color Doppler ultrasound is useful during diagnostic and follow-up phase...
2016: Contributions to Nephrology
https://www.readbyqxmd.com/read/27169885/clinical-scenarios-in-acute-kidney-injury-parenchymal-acute-kidney-injury-tubulo-interstitial-diseases
#5
Mario Meola, Sara Samoni, Ilaria Petrucci, Claudio Ronco
Acute tubular necrosis (ATN) is the most common type of acute kidney injury (AKI) related to parenchymal damage (90% of cases). It may be due to a direct kidney injury, such as sepsis, drugs, toxins, contrast media, hemoglobinuria and myoglobinuria, or it may be the consequence of a prolonged systemic ischemic injury. Conventional ultrasound (US) shows enlarged kidneys with hypoechoic pyramids. Increased volume is largely sustained by the increase of anteroposterior diameter, while longitudinal axis usually maintains its normal length...
2016: Contributions to Nephrology
https://www.readbyqxmd.com/read/27169876/clinical-scenarios-in-chronic-kidney-disease-kidneys-structural-changes-in-end-stage-renal-disease
#6
Mario Meola, Sara Samoni, Ilaria Petrucci
Acquired cystic kidney disease (ACKD) and renal cell carcinoma (RCC) are the most important manifestations of end-stage kidneys' structural changes. ACKD is caused by kidney damage or scarring and it is characterized by the presence of small, multiple cortical and medullary cysts filled with a fluid similar to preurine. ACKD prevalence varies according to predialysis and dialysis age and its pathogenesis is unknown, although it is stated that progressive destruction of renal tissue induces hypertrophy/compensatory hyperplasia of residual nephrons and may trigger the degenerative process...
2016: Contributions to Nephrology
https://www.readbyqxmd.com/read/27169751/clinical-scenarios-in-acute-kidney-injury-hepatorenal-syndrome
#7
Mario Meola, Federico Nalesso, Ilaria Petrucci, Sara Samoni, Claudio Ronco
Renal failure commonly occurs in patients affected by cirrhosis, especially when there is ascites. It is typically secondary to intercurrent events that can further compromise blood flow in conditions of relatively decreased renal perfusion. Hepatorenal syndrome (HRS) is a particular and common type of kidney failure that affects patients with liver cirrhosis or, less frequently, with fulminant hepatic failure. The syndrome is characterized by splanchnic vasodilation and renal vasoconstriction. The classification of HRS identifies 2 categories of kidney failure, known as type 1 and type 2 HRS, that occur in patients with either cirrhosis or fulminant hepatic failure...
2016: Contributions to Nephrology
https://www.readbyqxmd.com/read/27169740/clinical-scenarios-in-chronic-kidney-disease-cystic-renal-diseases
#8
Mario Meola, Sara Samoni, Ilaria Petrucci
Cysts are frequently found in chronic kidney disease (CKD) and they have a different prognostic significance depending on the clinical context. Simple solitary parenchymal cysts and peripelvic cysts are very common and they have no clinical significance. At US, simple cyst appears as a round anechoic pouch with regular and thin profiles. On the other hand, hereditary polycystic disease is a frequent cause of CKD in children and adults. Autosomal dominant polycystic kidney disease (ADPKD) and autosomal recessive polycystic kidney disease (ARPKD) are the best known cystic hereditary diseases...
2016: Contributions to Nephrology
https://www.readbyqxmd.com/read/27169621/clinical-scenarios-in-acute-kidney-injury-pre-renal-acute-kidney-injury
#9
Mario Meola, Federico Nalesso, Ilaria Petrucci, Sara Samoni, Claudio Ronco
Approximately 70% of community-acquired cases of acute kidney injury are attributed to pre-renal causes. In most of these cases, the underlying kidney function may be normal, but decreased renal perfusion associated with low intravascular volume or decreased arterial pressure can determine a reduced glomerular filtration rate (GFR). Autoregulatory mechanisms can partially compensate renal perfusion reduction in order to maintain GFR. In patients with pre-existing chronic kidney disease, however, these mechanisms are impaired, and the susceptibility to develop acute-on-chronic renal failure is higher...
2016: Contributions to Nephrology
https://www.readbyqxmd.com/read/27169608/clinical-scenarios-in-chronic-kidney-disease-chronic-tubulointerstitial-diseases
#10
Mario Meola, Sara Samoni, Ilaria Petrucci
Chronic tubulointerstitial diseases are a common final pathway toward chronic renal failure regardless the primary damage (glomerular, vascular or directly the tubulointerstitium). Chronic tubulointerstitial nephritis (CTN) is characterized by interstitial scarring, fibrosis and tubule atrophy, resulting in progressive chronic kidney disease. Most frequent causes of CTN are drugs, heavy metals, obstructive uropathy, nephrolithiasis, reflux disease, immunologic diseases, neoplasia, ischemia, metabolic diseases, genetics and miscellaneous...
2016: Contributions to Nephrology
https://www.readbyqxmd.com/read/27169556/ultrasound-in-acute-kidney-disease
#11
Mario Meola, Federico Nalesso, Ilaria Petrucci, Sara Samoni, Claudio Ronco
Kidneys' imaging provides useful information in acute kidney injury (AKI) diagnosis and management. Today, several imaging techniques give information on kidneys anatomy, urinary obstruction, differential diagnosis between AKI and chronic kidney disease (CKD), renal blood flow and glomerular filtration rate. Ultrasound is a safe, non-invasive and repeatable imaging technique so it is widely used in the first level work-up of AKI. The utility of contrast-enhanced computed tomography and magnetic resonance imaging in AKI or in AKI during CKD is limited because of renal toxicity associated with contrast agents used...
2016: Contributions to Nephrology
https://www.readbyqxmd.com/read/27169551/clinical-scenarios-in-chronic-kidney-disease-parenchymal-chronic-renal-diseases-part-2
#12
Ilaria Petrucci, Sara Samoni, Mario Meola
Secondary nephropathies can be associated with disreactive immunological disorders or with a non-inflammatory glomerular damage. In systemic lupus erythematosus (SLE), scleroderma and rheumatoid arthritis as in other connective tissue diseases, kidney volume and cortex echogenicity are the parameters that best correlate with clinical severity of the disease, even if the morphological aspect is generally non-specific. Doppler studies in SLE document the correlation between resistance indexes (RIs) values and renal function...
2016: Contributions to Nephrology
https://www.readbyqxmd.com/read/27169469/pathophysiology-and-clinical-work-up-of-acute-kidney-injury
#13
Mario Meola, Federico Nalesso, Ilaria Petrucci, Sara Samoni, Claudio Ronco
Acute kidney injury (AKI), also known in the past as acute renal failure, is a syndrome characterized by the rapid loss of kidney excretory function. It is usually diagnosed by the accumulation of end products of nitrogen metabolism (urea and creatinine) or decreased urine output or both. AKI is the clinical consequence of several disorders that acutely affect the kidney, causing electrolytes and acid-base imbalance, hyperhydration and loss of depurative function. AKI is common in critical care patients in whom it is often secondary to extrarenal events...
2016: Contributions to Nephrology
https://www.readbyqxmd.com/read/27169382/clinical-scenarios-in-chronic-kidney-disease-parenchymal-chronic-renal-diseases-part-1
#14
Ilaria Petrucci, Sara Samoni, Mario Meola
In diabetes, kidneys' morphological changes are non-specific at ultrasound (US) and they vary according to disease stage. In the earlier stages, kidneys are enlarged and diffusely hypoechoic due to hyperfiltration. Kidneys size decreases only in advanced stages whereas renal cortical echogenicity progressively increases due to glomerulosclerosis. Nephromegaly, as well as discrepancy between size and renal function, are typical features of diabetic nephropathy either in early or in advanced stages of the disease...
2016: Contributions to Nephrology
https://www.readbyqxmd.com/read/26882338/timing-of-renal-replacement-therapy-in-acute-kidney-injury
#15
Marlies Ostermann, Ron Wald, Sean M Bagshaw
BACKGROUND: Renal replacement therapy (RRT) is commonly and increasingly utilized in critically ill patients with severe acute kidney injury (AKI). The issue of when to start RRT in a critically ill patient with AKI has long troubled clinicians. SUMMARY: Currently, there is a paucity of high-quality evidence to guide clinician decision-making on the optimal time to start RRT. This lack of evidence has translated into wide variation in treatment patterns and practices...
2016: Contributions to Nephrology
https://www.readbyqxmd.com/read/26882226/fluid-management-in-acute-kidney-injury
#16
Chiao-Lin Chuang
The goal of fluid therapy in critical care medicine is to restore hemodynamic stability and vital organ perfusion while avoiding interstitial edema. Acute kidney injury (AKI) is a common complication in critically ill patients. Decisions regarding fluid management in critically ill patients with AKI are difficult, as these patients often have accompanying oliguria as well as body fluid overload. Both hypovolemia and volume overload are associated with increased morbidity and mortality in critical care patients; therefore, accurate assessment of the intravascular volume status as well as the response to fluid replacement remains one of the most challenging and important issues for clinicians in daily practice...
2016: Contributions to Nephrology
https://www.readbyqxmd.com/read/26882100/electronic-data-systems-and-acute-kidney-injury
#17
Wisit Cheungpasitporn, Kianoush Kashani
Acute kidney injury (AKI) is a serious condition that is associated with an increased risk of death, long hospital stays, and high healthcare costs. The best chance of ameliorating the severity of AKI and improving its outcomes is through early recognition and intervention. Electronic health records (EHRs) have now become an integrated part of medical practice in most clinical settings worldwide. Appropriate use of EHRs potentially improves patient care, while poorly designed EHRs could result in unintended consequences...
2016: Contributions to Nephrology
https://www.readbyqxmd.com/read/26882035/renal-recovery-after-acute-kidney-injury
#18
Etienne Macedo, Ravindra L Mehta
Until recently, patients surviving an episode of acute kidney injury (AKI) were assumed to have a good renal prognosis. This belief was predominantly based on studies that used heterogeneous AKI definitions and that considered renal recovery as dialysis independence at hospital discharge. Since standardized definitions of AKI have become available, several studies have established an association between AKI and adverse clinical outcomes. It is now well recognized that while the glomerular filtration rate generally improves after AKI, the renal recovery process is often incomplete and can result in a chronic decrease in kidney function...
2016: Contributions to Nephrology
https://www.readbyqxmd.com/read/26882009/the-acute-kidney-injury-to-chronic-kidney-disease-transition-a-potential-opportunity-to-improve-care-in-acute-kidney-injury
#19
Carlos E Palant, Richard L Amdur, Lakhmir S Chawla
Recent controlled trials, epidemiological analyses and basic research studies offer a comprehensive view of the short and long-term clinical repercussion of de novo acute kidney injury or AKI. While most post-AKI patients recover their baseline renal function, a significant number, approximately ~20% of those affected, will go on to develop long term illness characterized by an increase in late stage CKD, cardiovascular complications, and increased death rates. When AKI occurs in hospitalized patients, selected demographic and laboratory results can be incorporated into risk calculators that identify those at higher risk for long-term complications...
2016: Contributions to Nephrology
https://www.readbyqxmd.com/read/26881939/acute-kidney-injury-prevention
#20
Tushar A Chopra, Charles H Brooks, Mark D Okusa
Acute kidney injury (AKI) is a condition associated with significant morbidity and mortality. The incidence of AKI is increasing due to predisposing factors (sepsis, nephrotoxins, and hypotension). This review will focus on the risk stratification of patients vulnerable to developing AKI in whom the timing of the insult is known (e.g., cardiac surgery, contrast exposure) as well as the clinical context in which the risk intensifies. The review will also focus on preventive measures and different pharmacological agents for preventing AKI...
2016: Contributions to Nephrology
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