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Renal Supportive care

Arunkumar Subbiah, Sandeep Mahajan, Raj Kanwar Yadav, Sanjay Kumar Agarwal
A 45-year-old man presented 4 months after ABOi renal transplantation with febrile illness and bicytopenia necessitating cessation of mycophenolate mofetil. Dengue non-structural protein 1 antigen (NS1 Ag) test was positive. Lowest total leucocyte count was 3.1×109 /L and platelet count was 14×109 /L. As fever subsided, patient became tachypneic with abdominal distention and hypotension. Ultrasonographic evaluation revealed ascites, gall bladder wall oedema and bilateral pleural effusion consistent with dengue capillary leak syndrome...
June 19, 2018: BMJ Case Reports
Gillian E Caughey, Jodie B Hillen, Stephanie Bacon, Nicholas Bullock, Virginia Bullock, Lisa Kalisch Ellett
Initial assessment: Older people are at increased risk of medication-related potentially preventable hospitalizations (MR-PPH) due to the presence of multiple chronic conditions (multimorbidity) and subsequent polypharmacy. Choice of solution: A pilot study was conducted, using evidence-based indicators to detect older patients in a chronic disease management program (CDMP) at risk of hospitalization due to sub-optimal medication use. Implementation: Previously validated indicators for MR-PPH were applied to patients with multimorbidity, aged 65 years or older and who were enrolled in a national community-based CDMP...
June 18, 2018: International Journal for Quality in Health Care
Tahrin Mahmood, Robert Puckrin, Linda Sugar, David Naimark
Rationale: Staphylococcus-associated glomerulonephritis (SAGN) is a rare immune complex-mediated glomerulonephritis associated with active Staphylococcus infection. We report a case illustrating the importance of clinical history and kidney biopsy findings in establishing the correct diagnosis. Presenting concerns of the patient: We report the case of a 64-year-old man with alcohol-associated cirrhosis, type 2 diabetes mellitus, and hypertension who presented to hospital with lower back and abdominal pain, rectal bleeding, a purpuric lower extremity rash, and oliguric acute kidney injury with microscopic hematuria and nephrotic-range proteinuria...
2018: Canadian Journal of Kidney Health and Disease
Désirée Louise Draeger, Karl-Dietrich Sievert, Oliver W Hakenberg
Background: The experience of stress in patients with cancer through helplessness and the suppression of emotions correlates with unfavorable disease prognosis. Significant distress can reduce survival probability as well as subjectively perceived poor quality of life. Currently, there are few data on psychological stress in patients with renal cancer and most studies focus on survival time. The aim of the study was to evaluate the psychosocial stress of patients with renal cancer with screening questionnaires for an inpatient psychosocial treatment program...
June 2018: Therapeutic Advances in Urology
Kanika Taneja, Sohrab Arora, Craig G Rogers, Nilesh S Gupta, Sean R Williamson
AIMS: Pathologic staging of renal cell carcinoma (RCC) can be challenging compared to other cancer types, as invasion often manifests as finger-like protrusions into vascular spaces or renal sinus tissue. Although prior studies have shown larger tumour size to be highly correlated with renal sinus invasion, prospective data on evaluating pathologic stage are limited. We evaluated a large series reported by a single urologic pathologist. METHODS AND RESULTS: Three hundred consecutive specimens were reviewed...
June 13, 2018: Histopathology
Aisha Tamika McKenzie, Gulen Addis
AIMS AND OBJECTIVES: The aim of this study was to examine the experience of registered nurses working in renal inpatients wards at an acute National Health Service (NHS) hospital Trust. Nurse perceptions of their experience particularly in relation to job satisfaction was analysed. BACKGROUND: Increased understanding of workplace organisation and culture can contribute to improved nurse work experience and better patient care. Worldwide many studies conducted on nurse experience and job satisfaction show that job satisfaction level varies across work settings so analysis of job satisfaction at a local level such as in a ward is important for producing useful analysis and recommendations...
June 13, 2018: Journal of Clinical Nursing
Yelena Slinin, Megha Babu, Areef Ishani
BACKGROUND: Ultrafiltration rate (UFR) has attracted attention as a modifiable aspect of volume management. OBJECTIVE: The objective of this review is to summarize the evidence that links UFR to patient outcomes and discuss UFR cut-offs proposed, and discuss possible consequences of adapting UFR as a quality metric. RESULTS: Higher UFRs has been associated with younger age, longer dialysis vintage, greater prevalence of comorbidities, higher Kt/V, lower weight, greater interdialytic weight gain, lower residual renal function, and shorter treatment times...
June 8, 2018: Seminars in Dialysis
Andrew Willis, Winston Crasto, Laura Gray, Helen Dallosso, Ghazala Waheed, Geri Gray, Melanie J Davies, Kamlesh Khunti
BACKGROUND: Adherence to evidence-based cardiovascular risk factor targets in patients with type 2 diabetes and microalbuminuria has shown long-term reduction in mortality and morbidity. Strategies to achieve such adherence have been delivered at individual patient level and are not cost-effective. Health care professional-level intervention has the potential to promote better adherence at lower cost. OBJECTIVE: The aim of this study was to assess the effectiveness of a multifactorial technology-driven intervention comprising health care professional training, a software prompt installed on practice systems, clinician email support, and enhanced performance and feedback reporting...
June 8, 2018: JMIR Research Protocols
Brooke A Spaeth, Billingsley Kaambwa, Mark Ds Shephard, Rodney Omond
Aim: To determine the cost-effectiveness of utilizing point-of-care testing (POCT) on the Abbott i-STAT device as a support tool to aid decisions regarding the emergency medical retrievals of patients at remote health centers in the Northern Territory (NT) of Australia. Methods: A decision analytic simulation model-based economic evaluation was conducted using data from patients presenting with three common acute conditions (chest pain, chronic renal failure due to missed dialysis session(s), and acute diarrhea) at six remote NT health centers from July to December 2015...
2018: ClinicoEconomics and Outcomes Research: CEOR
Michelle Ma, Katie Falloon, Po-Hung Chen, Behnam Saberi, Aliaksei Pustavoitau, Elif Ozdogan, Zhiping Li, Benjamin Philosophe, Andrew M Cameron, Ahmet Gurakar
Acute alcoholic hepatitis is a syndrome of jaundice and hepatic decompensation that occurs with excessive alcohol consumption. The diagnosis can be made with a combination of clinical characteristics and laboratory studies, though biopsy may be required in unclear cases. Acute alcoholic hepatitis can range from mild to severe disease, as determined by a Maddrey discriminant function ≥32. Mild forms can be managed with supportive care and abstinence from alcohol. While mild form has an overall good prognosis, severe alcoholic hepatitis is associated with an extremely high short-term mortality of up to 50%...
January 1, 2018: Journal of Intensive Care Medicine
Pierre I Karakiewicz, Emanuele Zaffuto, Anil Kapoor, Naveen S Basappa, Georg A Bjarnason, Normand Blais, Rodney H Breau, Christina Canil, Darrel Drachenberg, Sebastien J Hotte, Claudio Jeldres, Michael A S Jewett, Wassim Kassouf, Christian Kollmannsberger, Luke T Lavallée, Ranjena Maloni, Francois Patenaude, Frédéric Pouliot, M Neil Reaume, Robert Sabbagh, Bobby Shayegan, Alan So, Denis Soulières, Simon Tanguay, Lori Wood, Marco Bandini
INTRODUCTION: The Kidney Cancer Research Network of Canada (KCRNC) collaborated to prepare this consensus statement about the use of target agents as adjuvant therapy in patients with non-metastatic renal cell carcinoma (nmRCC) after nephrectomy. We reviewed the published data and performed a meta-analysis of studies that focused on vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKIs). METHODS: A systematic literature search identified seven trials on adjuvant target therapy in nmRCC...
June 2018: Canadian Urological Association Journal, Journal de L'Association des Urologues du Canada
Amna Hamid, Murtaza F Dhrolia, Ruqayya Qureshi, Salman Imtiaz, Aasim Ahmad
Chikungunya fever is an arthropod-borne viral illness characterised by high grade fever and incapacitating arthralgias. It is considered benign; however, in the recent outbreaks, several complications have been reported worldwide. We report a case of male patient with Chikungunya fever, possibly contracted from infected mosquitoes endemic in Karachi, Pakistan. The clinical presentation included fever, myalgias and anuria. Investigations revealed renal failure and significantly raised creatinine phosphokinase (CPK), suggesting rhabdomyolysis to be the cause of acute kidney injury (AKI)...
June 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Marissa A Brunetti, J William Gaynor, Lauren B Retzloff, Jessica L Lehrich, Mousumi Banerjee, Venugopal Amula, David Bailly, Darren Klugman, Josh Koch, Javier Lasa, Sara K Pasquali, Michael Gaies
OBJECTIVES: Cardiopulmonary failure in children with cardiac disease differs from the general pediatric critical care population, yet the epidemiology of extracorporeal membrane oxygenation support in cardiac ICUs has not been described. We aimed to characterize extracorporeal membrane oxygenation utilization and outcomes across surgical and medical patients in pediatric cardiac ICUs. DESIGN: Retrospective analysis of the Pediatric Cardiac Critical Care Consortium registry to describe extracorporeal membrane oxygenation frequency and outcomes...
June 2018: Pediatric Critical Care Medicine
S K Sureka, P Yadav, P Kumar, A Srivastava
A 46-year-old male presented with left flank pain and was found to have left nephromegaly with renal vein and inferior vena cava (IVC) thrombus. On hematological evaluation, he had leukocytosis and thrombocytopenia. Further evaluation revealed acute myeloid leukemia (AML). Following initial cytoreductive therapy and supportive care for hyperleukocytosis, he underwent left simple nephrectomy with IVC thrombectomy. Postoperatively, he developed massive thrombosis of infrahepatic IVC with renal failure. Renal venous thrombosis as a rare presentation of AML in adults with leukemic hyperleukocytosis has not been reported...
March 2018: Indian Journal of Nephrology
K Mehta, A Pajai, S Bhurke, A Shirkande, R Bhadade, R D'Souza
The epidemiological pattern of acute kidney injury (AKI) in tropical countries during monsoon reflects infectious disease as the most important cause. AKI is a confounding factor and may be overlooked by primary health-care providers and underreported in health statistics. The present study prospectively helps estimate the burden of disease and analyze etiology, clinical profile, and outcome in a tertiary care hospital of a metropolitan city in a tropical country. The study period included monsoon season of 2012 and 2013, a total of 8 months...
March 2018: Indian Journal of Nephrology
Arnaud Méjean, Alain Ravaud, Simon Thezenas, Sandra Colas, Jean-Baptiste Beauval, Karim Bensalah, Lionnel Geoffrois, Antoine Thiery-Vuillemin, Luc Cormier, Hervé Lang, Laurent Guy, Gwenaelle Gravis, Frederic Rolland, Claude Linassier, Eric Lechevallier, Christian Beisland, Michael Aitchison, Stephane Oudard, Jean-Jacques Patard, Christine Theodore, Christine Chevreau, Brigitte Laguerre, Jacques Hubert, Marine Gross-Goupil, Jean-Christophe Bernhard, Laurence Albiges, Marc-Olivier Timsit, Thierry Lebret, Bernard Escudier
Background Cytoreductive nephrectomy has been the standard of care in metastatic renal-cell carcinoma for 20 years, supported by randomized trials and large, retrospective studies. However, the efficacy of targeted therapies has challenged this standard. We assessed the role of nephrectomy in patients with metastatic renal-cell carcinoma who were receiving targeted therapies. Methods In this phase 3 trial, we randomly assigned, in a 1:1 ratio, patients with confirmed metastatic clear-cell renal-cell carcinoma at presentation who were suitable candidates for nephrectomy to undergo nephrectomy and then receive sunitinib (standard therapy) or to receive sunitinib alone...
June 3, 2018: New England Journal of Medicine
L S Vest, F M Koraishy, Z Zhang, N N Lam, M A Schnitzler, V R Dharnidharka, D Axelrod, A S Naik, T A Alhamad, B L Kasiske, G P Hess, K L Lentine
While guidelines support metformin as a therapeutic option for diabetic patients with mild-to-moderate renal insufficiency, the frequency and outcomes of metformin use in kidney transplant recipients are not well described. We integrated national U.S. transplant registry data with records from a large pharmaceutical claims clearinghouse (2008-2015). Associations (adjusted hazard ratio, 95% LCL aHR95% UCL ) of diabetes regimens (with and excluding metformin) in the first year post-transplant with patient and graft survival over the subsequent year were quantified by multivariate Cox regression, adjusted for recipient, donor, and transplant factors and propensity for metformin use...
May 31, 2018: Clinical Transplantation
Jeffrey R Suchard
A 43-year-old man ingested a chlorothalonil-containing fungicide in a suicide attempt. The patient was found to have acute kidney injury from acute tubular necrosis on hospital admission (serum creatinine 2.9 mg/dL), although his renal function recovered with hydration and supportive care. Acute toxicity from chlorothalonil ingestion has been described very rarely, and no previous cases have described clinically-significant renal effects.
November 2017: Clinical practice and cases in emergency medicine
Mariele De Santi, Caroline do Couto, Karin Werther
Digenetic eucotylids of the Paratanaisia genus are widely reported parasites of the avian renal system. The infection, commonly reported in free-living and zoo-housed birds, is described for the first time in a domiciled bird, a cockatiel kept as pet bird with free access to the yard outdoors. The bird was received at Veterinary Hospital, where clinical and radiographic evaluations suggested a case of heavy-metal poisoning. Although the bird received supportive care and a chelating agent, it died the next day...
May 24, 2018: Revista Brasileira de Parasitologia Veterinária, Brazilian Journal of Veterinary Parasitology
Aldo García-Covarrubias, Luis García-Covarrubias, Dulce A Alcántara-López, Héctor Hinojosa-Heredia, Paola Prieto-Olivares, Arturo Reding-Bernal
Antecedents: In the field of organ donation and procurement, a possible donor is a patient with severe neurological damage and appropriate medical criteria for donation, and a potential donor is a patient suspected of being brain dead. Objective: The aim of this study is to identify specific factors that cause the loss of possible multiorgan donors in an intensive care unit (ICU). Methods: A review of cross-sectional charts of possible liver and kidney donors was done with patients admitted to the ICU with full respiratory support and Glasgow score < 8...
2018: Cirugia y Cirujanos
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