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Fluid management in kidney transplantation

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https://www.readbyqxmd.com/read/29742659/anhydramnios-in-the-setting-of-renal-malformations-the-national-institutes-of-health-workshop-summary
#1
Marva Moxey-Mims, Tonse N K Raju
Anhydramnios in the setting of severe malformations of the fetal kidney and urinary tract is associated with a high incidence of stillbirths and life-threatening complications, including severe pulmonary hypoplasia, umbilical cord compression, and perinatal asphyxia. To prevent such adverse outcomes, some centers in the United States and elsewhere are offering amniotic fluid restoration for women diagnosed with anhydramnios in the setting of fetal renal malformations. The procedures include infusions of amniotic fluid substitutes (normal saline), percutaneously or through an amnioport-an implanted system for serial or continuous infusion of normal saline to maintain the desired amniotic fluid volume...
May 7, 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29695308/the-presence-of-human-mesenchymal-stem-cells-of-renal-origin-in-amniotic-fluid-increases-with-gestational-time
#2
Md Shaifur Rahman, Lucas-Sebastian Spitzhorn, Wasco Wruck, Carsten Hagenbeck, Percy Balan, Nina Graffmann, Martina Bohndorf, Audrey Ncube, Pascale V Guillot, Tanja Fehm, James Adjaye
BACKGROUND: Established therapies for managing kidney dysfunction such as kidney dialysis and transplantation are limited due to the shortage of compatible donated organs and high costs. Stem cell-based therapies are currently under investigation as an alternative treatment option. As amniotic fluid is composed of fetal urine harboring mesenchymal stem cells (AF-MSCs), we hypothesized that third-trimester amniotic fluid could be a novel source of renal progenitor and differentiated cells...
April 25, 2018: Stem Cell Research & Therapy
https://www.readbyqxmd.com/read/29593185/effectiveness-of-using-non-invasive-continuous-arterial-pressure-monitoring-with-clearsight-in-hemodynamic-monitoring-during-living-renal-transplantation-in-a-recipient-a-case-report
#3
Nami Kakuta, Yasuo M Tsutsumi, Chiaki Murakami, Yoko Sakai, Takuro Oyama, Asuka Kasai, Katsuyoshi Kume, Katsuya Tanaka
We investigated the effectiveness of the ClearSight system for hemodynamic management during kidney transplantation for a recipient. The recipient was to receive a kidney transplant from his mother under general anesthesia. We used continuous noninvasive finger-cuff-based monitoring of blood pressure, provided by the ClearSight system, and stroke volume variation to predict fluid responsiveness. We used of a balanced anesthetic technique and stringent monitoring standards to ensure a successful outcome for the patient...
2018: Journal of Medical Investigation: JMI
https://www.readbyqxmd.com/read/29579888/severe-scedosporium-apiospermum-infection-in-a-recent-renal-transplant-recipient-case-report
#4
M J Torres-Sánchez, E Hernández-García, J Gómez-Sánchez, M Palomares-Bayo, M Peña-Ortega, P Galindo-Sacristán, C De Gracia-Guindo, A Osuna-Ortega
Infections in transplanted patients are still an important cause of morbidity and mortality. Among them, fungal infections with pathogens have become increasingly more prevalent in the last decade. We report the clinical course and management of disseminated Scedosporium apiospermum infection in a kidney transplant recipient, with microbiological isolation of the fungus in cerebrospinal fluid culture. S apiospermum is a fungus that is distributed worldwide and can be grown from soil samples or stagnant water...
March 2018: Transplantation Proceedings
https://www.readbyqxmd.com/read/29526051/central-venous-pressure-monitoring-in-living-donor-kidney-recipients-does-not-affect-immediate-graft-function-a-propensity-score-analysis
#5
Dieter Adelmann, Leonie Bicknell, Claus U Niemann, John Feiner, Garrett R Roll, Lyle Burdine, Elizabeth L Whitlock
BACKGROUND: During kidney transplantation, intraoperative fluid management can affect post-transplant graft function. It is unclear whether or not central venous pressure (CVP) monitoring is required to guide fluid therapy during kidney transplantation. METHODS: We compared post-transplant graft function in recipients of living donor kidney transplants between August 2006 and March 2009 based on the use or absence of intraoperative CVP monitoring. Graft function, assessed using the creatinine reduction ratio on postoperative day 2 (CCR2), was evaluated by multivariable linear regression analysis and in a propensity-matched cohort...
March 11, 2018: Clinical Transplantation
https://www.readbyqxmd.com/read/29388370/the-role-of-continuous-renal-replacement-therapy-in-the-management-of-acute-kidney-injury-associated-with-sinusoidal-obstruction-syndrome-following-hematopoietic-cell-transplantation
#6
Rupesh Raina, Ghada A Abusin, Prashant Vijayaraghavan, Jeffery J Auletta, Linda Cabral, Hasan Hashem, Beth A Vogt, Kenneth R Cooke, Rolla F Abu-Arja
Maintaining fluid balance, pre- and post-MA-HCT is essential and usually requires frequent administration of diuretics. Hepatic sinusoidal obstructive syndrome is potentially life-threatening, especially when associated with AKI and MOF. This study describes six patients who developed AKI-associated SOS and diuretic-resistant FO who subsequently underwent CRRT using standardized management guidelines for fluid balance post-HCT. Retrospective chart review was done for HCT patients between September 2011 and October 2013 at a tertiary care children's hospital...
March 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29368625/perioperative-fluid-management-in-kidney-transplantation-a-black-box
#7
REVIEW
Maria Helena Calixto Fernandes, Thomas Schricker, Sheldon Magder, Roupen Hatzakorzian
The incidence of delayed graft function in patients undergoing kidney transplantation remains significant. Optimal fluid therapy has been shown to decrease delayed graft function after renal transplantation. Traditionally, the perioperative volume infusion regimen in this patient population has been guided by central venous pressure as an estimation of the patient's volume status and mean arterial pressure, but this is based on sparse evidence from mostly retrospective observational studies. Excessive volume infusion to the point of no further fluid responsiveness can damage the endothelial glycocalyx and is no longer considered to be the best approach...
January 25, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29298736/multiple-frequency-bioimpedance-devices-for-fluid-management-in-people-with-chronic-kidney-disease-receiving-dialysis-a-systematic-review-and-economic-evaluation
#8
Graham Scotland, Moira Cruickshank, Elisabet Jacobsen, David Cooper, Cynthia Fraser, Michal Shimonovich, Angharad Marks, Miriam Brazzelli
BACKGROUND: Chronic kidney disease (CKD) is a long-term condition requiring treatment such as conservative management, kidney transplantation or dialysis. To optimise the volume of fluid removed during dialysis (to avoid underhydration or overhydration), people are assigned a 'target weight', which is commonly assessed using clinical methods, such as weight gain between dialysis sessions, pre- and post-dialysis blood pressure and patient-reported symptoms. However, these methods are not precise, and measurement devices based on bioimpedance technology are increasingly used in dialysis centres...
January 2018: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/29234200/nutrition-and-muscle-in-cirrhosis
#9
REVIEW
Anil C Anand
As the cirrhosis progresses, development of complication like ascites, hepatic encephalopathy, variceal bleeding, kidney dysfunction, and hepatocellular carcinoma signify increasing risk of short term mortality. Malnutrition and muscle wasting (sarcopenia) is yet other complications that negatively impact survival, quality of life, and response to stressors, such as infection and surgery in patients with cirrhosis. Conventionally, these are not routinely looked for, because nutritional assessment can be a difficult especially if there is associated fluid retention and/or obesity...
December 2017: Journal of Clinical and Experimental Hepatology
https://www.readbyqxmd.com/read/29149961/practice-variation-in-the-immediate-postoperative-care-of-pediatric-kidney-transplantation-a-national-survey
#10
S Abu-Sultaneh, M J Hobson, A C Wilson, W C Goggins, M E Nitu, R Lutfi
INTRODUCTION: Advances in organ allocation, surgical technique, immunosuppression, and long-term follow-up have led to a significant improvement in kidney transplant outcomes. Although there are clear recommendations for several aspects of kidney transplant management, there are no pediatric-specific guidelines for immediate postoperative care. The aim of this survey is to examine practice variations in the immediate postoperative care of pediatric kidney transplant patients. METHODS: We surveyed medical directors of Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)-affiliated pediatric intensive care units regarding center-specific immediate postoperative management of pediatric kidney transplantation...
November 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28868984/the-new-kidney-donor-allocation-system-and-implications-for-anesthesiologists
#11
Srikanth Sridhar, Sara Guzman-Reyes, Sam D Gumbert, Semhar J Ghebremichael, Angelina R Edwards, Mark J Hobeika, Wasim A Dar, Evan G Pivalizza
Given potential disparity and limited allocation of deceased donor kidneys for transplantation, a new federal kidney allocation system was implemented in 2014. Donor organ function and estimated recipient survival in this system has implications for perioperative management of kidney transplant recipients. Early analysis suggests that many of the anticipated goals are being attained. For anesthesiologists, implications of increased dialysis duration and burdens of end-stage renal disease include increased cardiopulmonary disease, challenging fluid, hemodynamic management, and central vein access...
September 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28801969/anesthetic-management-for-intestinal-transplantation-a-decade-of-experience
#12
Jeron Zerillo, Sang Kim, Bryan Hill, David Shapiro, Hung-Mo Lin, Alyssa Burnham, Jang Moon, Kishore Iyer, Samuel DeMaria
BACKGROUND: Intestinal transplantation (ITx) is the definitive therapy for patients suffering from intestinal failure. Previously published reports suggest that these cases should be managed perioperatively with the same intensive monitors and techniques as in liver transplantation. METHODS: We retrospectively reviewed the anesthetic management of 67 isolated intestinal, intestinal-pancreas, and intestinal-kidney transplants over the previous decade (2005-2015) in our tertiary care institution...
August 12, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28794844/a-case-series-on-simultaneous-liver-and-kidney-transplantation-do-we-need-intraoperative-renal-replacement-therapy
#13
Wongook Wi, Tae Soo Hahm, Gaab-Soo Kim
Since the implementation of the model for end-stage liver disease (MELD) scoring system in 2002, the liver transplantation (LT) society has observed a substantial increase in the number of recipients with renal dysfunction. Intraoperative renal replacement therapy (ioRRT) has emerged as one of the solutions available to manage high-MELD score recipients; however, its usefulness has not yet been proven. To date, we have experienced five cases of simultaneous liver and kidney transplantation (SLKT). Recipients of SLKT tend to have a lower pre-transplant kidney function and the longer operation time mandates a larger amount of fluid than LT alone...
August 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/28736994/intraoperative-hemodynamic-factors-predicting-early-postoperative-renal-function-in-pediatric-kidney-transplantation
#14
Daphné Michelet, Christopher Brasher, Lucile Marsac, Nabil Zanoun, Mona Assefi, Alaa Elghoneimi, Stephane Dauger, Souhayl Dahmani
BACKGROUND: The anesthetic management of kidney transplantation in children remains somewhat empirical. The goal of the present study was to investigate intraoperative hemodynamic factors affecting posttransplantation kidney function. METHODS: We performed a retrospective analysis of data from patients undergoing kidney transplantation in our pediatric teaching hospital from 2000 to 2014. Data collected included: donor and recipient demographic data, recipient comorbidities, fluids administered intraoperatively, and intraoperative blood pressure and central venous pressure...
September 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28639460/role-of-ct-scan-in-diagnosis-of-renal-lymphangiectasia-our-single-center-experience
#15
Vaidehi K Pandya, Harsh C Sutariya, Shruti P Gandhi, Sajni I Khemchandani, Himanshu V Patel, Maulin K Shah
BACKGROUND: Renal lymphangiectasia is rarely reported benign renal disorder of lymphatic malformation. Though found incidentally; it presents with nonspecific symptoms and shows characteristic findings in radiological imaging studies. AIM: Here, we report eight patients with symptoms, laboratory and imaging findings compatible with renal lymphangiectasia. This report describes clinical and laboratory characteristics, treatment, Imaging findings and outcome of a series of patients with renal lymphangiectasia and reviews the literature...
November 2017: Renal Failure
https://www.readbyqxmd.com/read/28552297/comparison-between-2-strategies-of-fluid-management-on-blood-loss-and-transfusion-requirements-during-liver-transplantation
#16
Nirmeen A Fayed, Khaled A Yassen, Ayat R Abdulla
OBJECTIVE: To compare the effects of low central venous pressure (LCVP) and transesophageal Doppler (TED)-guided fluid management on blood loss and blood transfusion during liver transplantation (LTx). DESIGN: Retrospective study. SETTING: Single institution, university hospital. PARTICIPANTS: Adult recipients of LTx. INTERVENTIONS: Two groups: control (LCVP G), n=45 with CVP maintained 40% lower than the preoperative value during the preanhepatic phase...
October 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28533908/ascites-refractory-ascites-and-hyponatremia-in-cirrhosis
#17
Brett Fortune, Andres Cardenas
Ascites is the most common complication related to cirrhosis and is associated with increased morbidity and mortality. Ascites is a consequence of the loss of compensatory mechanisms to maintain the overall effective arterial blood volume due to worsening splanchnic arterial vasodilation as a result of clinically significant portal hypertension. In order to maintain effective arterial blood volume, vasoconstrictor and antinatriuretic pathways are activated, which increase overall sodium and fluid retention...
May 2017: Gastroenterology Report
https://www.readbyqxmd.com/read/28465499/posterior-reversible-encephalopathy-syndrome-after-orthotopic-heart-transplantation-a-case-report
#18
Rigoberto Ramirez, Preetham Reddy Muskula, Mark P Everley
BACKGROUND Calcineurin inhibitor-induced posterior reversible encephalopathy syndrome (PRES) is well described in liver and kidney transplant patients, but there is a paucity of data in heart transplant patients. PRES syndrome in the setting of heart transplantation can occur as early as 5 days following transplantation. CASE REPORT A 32-year-old woman who had recently undergone orthotopic heart transplantation developed headaches, visual disturbances, and generalized tonic clonic seizures 5 days after initiating anti-rejection therapy (tacrolimus, mycophenolate, and prednisone)...
May 3, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28441936/rationale-and-design-of-bistro-a-randomized-controlled-trial-to-determine-whether-bioimpedance-spectroscopy-guided-fluid-management-maintains-residual-kidney-function-in-incident-haemodialysis-patients
#19
RANDOMIZED CONTROLLED TRIAL
Simon J Davies, Fergus J Caskey, David Coyle, Elizabeth Lindley, Jamie Macdonald, Sandip Mitra, Martin Wilkie, Andrew Davenport, Ken Farrington, Indranil Dasgupta, Paula Ormandy, Lazaros Andronis, Ivonne Solis-Trapala, Julius Sim
BACKGROUND: Preserved residual kidney function (RKF) and normal fluid status are associated with better patient outcomes in incident haemodialysis patients. The objective of this trial is to determine whether using bioimpedance technology in prescribing the optimal post-dialysis weight can reduce the rate of decline of RKF and potentially improve patient outcomes. METHODS/DESIGN: 516 pateints commencing haemodialysis, aged >18 with RKF of > 3 ml/min/1...
April 26, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/27921039/clinical-manifestation-and-management-of-adpkd-in-western-countries
#20
REVIEW
Claudia Sommerer, Martin Zeier
BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease in Western countries. The prevalence is between 2.4/10,000 and 3.9/10,000. ADPKD represents a systemic disease resulting in deterioration in renal function. Until now, mutations in two genes (PKD1 and PKD2) have been identified. Recently, the European Medicines Agency (EMA) approved the use of the vasopressin V2 receptor antagonist tolvaptan to slow the progression of cyst development and renal insufficiency connected with ADPKD in adult patients with chronic kidney disease stages 1-3 at initiation of treatment with evidence of rapidly progressing disease...
October 2016: Kidney Diseases
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