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Advances in Chronic Kidney Disease

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https://www.readbyqxmd.com/read/29229172/self-management-and-health-care-transition-among-adolescents-and-young-adults-with-chronic-kidney-disease-medical-and-psychosocial-considerations
#1
REVIEW
Maria E Díaz-González de Ferris, Marta Del Villar-Vilchis, Ricardo Guerrero, Victor M Barajas-Valencia, Emily B Vander-Schaaf, Alexandre de Pomposo, Mara Medeiros, Eniko Rak, Guillermo Cantu-Quintanilla, Rupesh Raina, Ana C Alvarez-Elias
Health care transition (HCT) is a process that requires preparation as a continuum from pediatric- to adult-focused services. For adolescents and young adults with chronic or ESRD, this process can be prolonged due to their physical, psychological, family, or ecological factors. HCT preparation is a matter of patient safety and patient rights as the consequences of poor preparation at the time of transfer to adult-focused services are great, including rejection of organs, disease relapse, or even death. We present a case to illustrate important points of HCT preparation, with suggestions for intervention by the interdisciplinary team members who serve (and will serve) these survivors of pediatric-onset health conditions...
November 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29229171/special-considerations-in-pediatric-kidney-transplantation
#2
REVIEW
Sean A Hebert, Rita D Swinford, David R Hall, Jason K Au, John S Bynon
Universally accepted as the treatment of choice for children needing renal replacement therapy, kidney transplantation affords children the opportunity for an improved quality of life over dialysis therapy. Immunologic and surgical advances over the last 15 years have improved the pediatric patient and kidney graft survival. Unique to pediatrics, congenital genitourinary anomalies are the most common primary diseases leading to kidney failure, many with urological issues. Early urological evaluation for post-transplant bladder dysfunction and emphasis on immunization adherence are the mainstays of pediatric pretransplant and post-transplant evaluations...
November 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29229170/care-of-the-pediatric-patient-on-chronic-dialysis
#3
REVIEW
Annabelle N Chua, Bradley A Warady
Optimal care of the pediatric end-stage renal disease (ESRD) patient on chronic dialysis is complex and requires multidisciplinary care as well as patient/caregiver involvement. The dialysis team, along with the family and patient, should all play a role in choosing the dialysis modality which best meets the patient's needs, taking into account special considerations and management issues that may be particularly pertinent to children who receive peritoneal dialysis or hemodialysis. Meticulous attention to dialysis adequacy in terms of solute and fluid removal, as well as to a variety of clinical manifestations of ESRD, including anemia, growth and nutrition, chronic kidney disease-mineral bone disorder, cardiovascular health, and neurocognitive development, is essential...
November 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29229169/acute-kidney-injury-in-children
#4
REVIEW
Scott M Sutherland, David M Kwiatkowski
Acute kidney injury (AKI) has become one of the more common complications seen among hospitalized children. The development of a consensus definition has helped refine the epidemiology of pediatric AKI, and we now have a far better understanding of its incidence, risk factors, and outcomes. Strategies for diagnosing AKI have extended beyond serum creatinine, and the most current data underscore the diagnostic importance of oliguria as well as introduce the concept of urinary biomarkers of kidney injury. As AKI has become more widespread, we have seen that it is associated with a number of adverse consequences including longer lengths of stay and greater mortality...
November 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29229168/monogenic-hypertension-in-children-a-review-with-emphasis-on-genetics
#5
REVIEW
Anjali Aggarwal, David Rodriguez-Buritica
Hypertension (HT) is a public health problem in children particularly related to the epidemic of overweight and obesity. Monogenic forms of HT are important in the differential diagnosis in children presenting with severe or refractory HT, who have a family history of early-onset HT, unusual physical examination findings, and/or characteristic hormonal and biochemical abnormalities. Most genetic defects in these disorders ultimately result in increased sodium transport in the distal nephron resulting in volume expansion and HT...
November 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29229167/glomerular-diseases-in-children
#6
REVIEW
Scott E Wenderfer, Joseph P Gaut
Unique challenges exist in the diagnosis and treatment of glomerular diseases with their onset during childhood. Mounting evidence supports the notion that earlier onset cases occur due to larger numbers of genetic risk alleles. Nearly all causes of adult-onset glomerulonephritis, nephrotic syndrome, and thrombotic microangiopathy have also been described in children, although the prevalence of specific causes differs. Postinfectious glomerulonephritis, Henoch-Schönlein purpura nephritis, and minimal change disease remain the most common causes of glomerular disease in younger children in the United States and can be diagnosed clinically without need for biopsy...
November 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29229166/holding-water-congenital-anomalies-of-the-kidney-and-urinary-tract-ckd-and-the-ongoing-role-of-excellence-in-plumbing
#7
REVIEW
Lars J Cisek
Congenital anomalies of the kidneys and urinary tracts can result in diminished natal kidney function, possibly through common embryologic pathway disruption or as a result of development taking place in the face of disordered 'post-renal' drainage. Impaired conduit and reservoir function present potential for an ongoing assault leading to further deterioration and progression of chronic kidney disease, a risk that extends to adults with these conditions, even after "correction". The drainage and storage aspects of the urinary system that can impact kidney function are reviewed with attention to correctable or manageable problems including: Bladder dysfunction wherein the low pressure storage of urine is compromised requiring the kidney to work against a pressure gradient, the classic post renal failure problem...
November 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29229165/measurement-and-estimation-of-glomerular-filtration-rate-in-children
#8
REVIEW
Ayesa N Mian, George J Schwartz
Rapid, accurate, and precise measures of kidney function are essential for daily management of patients. While plasma and urinary clearances provide the greatest accuracy for assessing glomerular filtration rate (GFR), these are often impractical particularly for the care of children. Serum creatinine, the most commonly used endogenous marker, is simple, convenient, and practical but less accurate because of the influence of non-GFR determinants such as muscle mass, which increases with age in children. GFR estimating equations have been developed for adults and children to improve the accuracy of endogenous biomarkers, such as creatinine and cystatin C, by accounting for some of the non-GFR determinants, thus enhancing the practitioner's ability to assess GFR...
November 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29229164/when-kidneys-grow-up
#9
EDITORIAL
Joshua A Samuels
No abstract text is available yet for this article.
November 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29229163/learning-from-kids
#10
EDITORIAL
Alicia Neu, Jerry Yee
No abstract text is available yet for this article.
November 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031361/treatment-of-disorders-of-sodium-balance-in-chronic-kidney-disease
#11
REVIEW
David H Ellison
Extracellular fluid volume expansion is nearly universal in patients with CKD. Such volume expansion has features similar to the syndrome of heart failure with preserved ejection fraction, which not only leads to symptoms but can also lead to further organ damage. Unique treatment challenges are present in this patient population, including low glomerular filtration, which limits sodium chloride filtration, intrinsic tubule predisposition to sodium chloride retention, and proteinuria. In addition, pharmacokinetic considerations alter the disposition of diuretics in patients with CKD and nephrotic syndrome...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031360/sodium-homeostasis-in-chronic-kidney-disease
#12
REVIEW
Vivek Soi, Jerry Yee
The pathologic consequences of sodium retention in the CKD population can lead to hypertension, edema, and progressive disease. Sodium excess is responsible for increases in oxidative stress, which alters kidney vasculature. As progression of CKD occurs, hyperfiltration by remaining nephrons compensates for an overall decrease in the filtered load of sodium. In the later stages of CKD, compensatory mechanisms are overcome and volume overload ensues. Nephrotic syndrome as it relates to sodium handling involves a different pathophysiology despite a common phenotype...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031359/treatment-of-abnormalities-of-potassium-homeostasis-in-ckd
#13
REVIEW
Biff F Palmer, Deborah J Clegg
Hyperkalemia, defined as serum potassium concentrations greater than 5.0 to 5.5 mEq/L, is a frequent occurrence in clinical practice because of the increasing incidence and prevalence of CKD. Patients at risk for this disorder are commonly treated with drugs that interfere in the renin-angiotensin-aldosterone system, thereby enhancing the occurrence and prevalence of this disorder. Discontinuation of these drugs because of the development of hyperkalemia deprives these patients the renal-protective and cardiovascular benefits this class of pharmacology has been shown to provide...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031358/hyperkalemia-and-hypokalemia-in-ckd-prevalence-risk-factors-and-clinical-outcomes
#14
REVIEW
Sarah Gilligan, Kalani L Raphael
Abnormalities of serum potassium are common in patients with CKD. Although hyperkalemia is a well-recognized complication of CKD, the prevalence rates of hyperkalemia (14%-20%) and hypokalemia (12%-18%) are similar. CKD severity, use of medications such as renin-angiotensin-aldosterone system inhibitors and diuretics, and dietary potassium intake are major determinants of serum potassium concentration in CKD. Demographic factors, acid-base status, blood glucose, and other comorbidities contribute as well. Both hyperkalemia and hypokalemia are associated with similarly increased risks of death, cardiovascular disease, and hospitalization...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031357/regulation-of-potassium-homeostasis-in-ckd
#15
REVIEW
Thomas D DuBose
Disturbances of potassium homeostasis can cause either hyperkalemia or hypokalemia and result in serious consequences. Although the consequences of acute and chronic hyperkalemia and treatment of these conditions in CKD have been widely appreciated by nephrologists, more recent information has focused attention on the consequences of chronic hypokalemia. Several recent studies have documented a "U-shaped" relationship between the serum [K+] and higher mortality in several clinical studies. The causes of dyskalemias are placed into the unique perspective of patients with CKD and its evolution with progression of CKD to later stages and focuses on the pathophysiology of these disorders...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031356/management-of-the-metabolic-acidosis-of-chronic-kidney-disease
#16
REVIEW
Nimrit Goraya, Donald E Wesson
Subjects with CKD and reduced glomerular filtration rate are at risk for chronic metabolic acidosis, and CKD is its most common cause. Untreated metabolic acidosis, even in its mildest forms, is associated with increased mortality and morbidity and should therefore be treated. If reduced glomerular filtration rate or the tubule abnormality causing chronic metabolic acidosis cannot be corrected, it is typically treated with dietary acid (H+) reduction using Na+-based alkali, usually NaHCO3. Dietary H+ reduction can also be accomplished with the addition of base-producing foods such as fruits and vegetables and limiting intake of H+-producing foods like animal-sourced protein...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031355/adverse-effects-of-the-metabolic-acidosis-of-chronic-kidney-disease
#17
REVIEW
Jeffrey A Kraut, Nicolaos E Madias
The kidney has the principal role in the maintenance of acid-base balance, and therefore, a fall in renal net acid excretion and positive H+ balance often leading to reduced serum [HCO3-] are observed in the course of CKD. This metabolic acidosis can be associated with muscle wasting, development or exacerbation of bone disease, hypoalbuminemia, increased inflammation, progression of CKD, protein malnutrition, alterations in insulin, leptin, and growth hormone, and increased mortality. Importantly, some of the adverse effects can be observed even in the absence of overt hypobicarbonatemia...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031354/epidemiology-of-acid-base-derangements-in-ckd
#18
REVIEW
Wei Chen, Matthew K Abramowitz
Acid-base disorders are in patients with chronic kidney disease, with chronic metabolic acidosis receiving the most attention clinically in terms of diagnosis and treatment. A number of observational studies have reported on the prevalence of acid-base disorders in this patient population and their relationship with outcomes, mostly focusing on chronic metabolic acidosis. The majority have used serum bicarbonate alone to define acid-base status due to the lack of widely available data on other acid-base disorders...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031353/regulation-of-acid-base-balance-in-chronic-kidney-disease
#19
REVIEW
Glenn T Nagami, L Lee Hamm
The kidneys play a major role in the regulation of acid-base balance by reabsorbing bicarbonate filtered by the glomeruli and excreting titratable acids and ammonia into the urine. In CKD, with declining kidney function, acid retention and metabolic acidosis occur, but the extent of acid retention depends not only on the degree of kidney impairment but also on the dietary acid load. Acid retention can occur even when the serum bicarbonate level is apparently normal. With reduced kidney function, acid transport processes in the surviving nephrons are augmented but as disease progresses ammonia excretion and, in some individuals, the ability to reabsorb bicarbonate falls, whereas titratable acid excretion is preserved until kidney function is severely impaired...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031352/disturbances-in-acid-base-potassium-and-sodium-balance-in-patients-with-ckd-new-insights-and-novel-therapies
#20
EDITORIAL
Jeffrey A Kraut
No abstract text is available yet for this article.
September 2017: Advances in Chronic Kidney Disease
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