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Interventional nephrology

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https://www.readbyqxmd.com/read/27899416/peritoneal-dialysis-access-revision-in-children-causes-interventions-and-outcomes
#1
Dagmara Borzych-Duzalka, T Fazil Aki, Marta Azocar, Colin White, Elizabeth Harvey, Sevgi Mir, Marta Adragna, Erkin Serdaroglu, Rajiv Sinha, Charlotte Samaille, Juan Jose Vanegas, Jameela Kari, Lorena Barbosa, Arvind Bagga, Monica Galanti, Onder Yavascan, Giovanna Leozappa, Maria Szczepanska, Karel Vondrak, Kei-Chiu Tse, Franz Schaefer, Bradley A Warady
BACKGROUND AND OBJECTIVES: Little published information is available about access failure in children undergoing chronic peritoneal dialysis. Our objectives were to evaluate frequency, risk factors, interventions, and outcome of peritoneal dialysis access revision. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Data were derived from 824 incident and 1629 prevalent patients from 105 pediatric nephrology centers enrolled in the International Pediatric Peritoneal Dialysis Network Registry between 2007 and 2015...
November 29, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27871159/-acute-kidney-injury-in-cirrhotic-patients-with-portal-hypertension
#2
REVIEW
So Mi Kim, Il Han Song
Acute kidney injury (AKI) is one of the most common manifestations encountered in clinical practice. It is associated with high morbidity and mortality in cirrhotic pre- and post-transplantation patients. Hepatorenal syndrome (HRS), a special form of AKI in cirrhotic patients, was recognized as a consequence of renal vasoconstriction from systemic/renal hemodynamic alterations developed in advanced cirrhosis with portal hypertension. Recently, multiple factors-such as infection/inflammation, underlying glomerulonephritis, bile cast, or increased abdominal pressure-have been considered to contribute to renal dysfunction in cirrhotic patients, which were presumed to induce HRS...
November 25, 2016: Korean Journal of Gastroenterology, Taehan Sohwagi Hakhoe Chi
https://www.readbyqxmd.com/read/27751612/nephrology-as-it-was-then-but-is-not-now
#3
Garabed Eknoyan
Diseases of the kidney are old, but the discipline dedicated to their study, nephrology, is barely more than 50 years old. As recounted in this recollection of those events, the rudiments of what would become nephrology emerged in the time between the 2 World Wars from basic studies of normal kidney function and flourished after the integration of their methodologies into clinical medicine thereafter. Although shaped by studies of kidney function in the 1960s, it was the subsequent advent of dialysis that fueled the growth of nephrology well into the 21st century...
October 14, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27749383/improving-treatment-for-patients-with-chronic-kidney-disease
#4
Kendra Thomsen, Kim Zuber, Jane Davis, Greg Thomas
OBJECTIVE: Kidneys in a Box (KIB) was developed to identify the effect of a performance improvement CME (PI-CME) project on the management of patients with diabetes who are at risk for chronic kidney disease (CKD). The program provided nonnephrology practitioners with research-based interventions known to slow CKD progression. METHODS: PAs were given the KIB tool kit, which described the scope of CKD identified high-risk diagnoses such as diabetes, and listed six modifiable risk factors that have been shown to slow progression of diabetic kidney disease when implemented...
November 2016: JAAPA: Official Journal of the American Academy of Physician Assistants
https://www.readbyqxmd.com/read/27738765/orphan-drug-policies-and-use-in-pediatric-nephrology
#5
EDITORIAL
Diana Karpman, Peter Höglund
Orphan drugs designed to treat rare diseases are often overpriced per patient. Novel treatments are sometimes even more expensive for patients with ultra-rare diseases, in part due to the limited number of patients. Pharmaceutical companies that develop a patented life-saving drug are in a position to charge a very high price, which, at best, may enable these companies to further develop drugs for use in rare disease. However, is there a limit to how much a life-saving drug should cost annually per patient? Government interventions and regulations may opt to withhold a life-saving drug solely due to its high price and cost-effectiveness...
January 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/27736815/acute-kidney-injury-electronic-alert-for-nephrologist-reactive-versus-proactive
#6
Kianoush Kashani, Claudio Ronco
Acute kidney injury (AKI) is a common complication of acute illnesses with significant impact on the mortality and morbidity. Early recognition of AKI allows clinicians to provide prophylactic interventions and to improve the outcomes of this deadly syndrome. Growing utilization and capabilities of electronic health records allow AKI risk stratification and early recognition with a potential effect on the processes of care and outcomes. We evaluate the current level of evidence on the impact of the AKI e-alert on the processes of care and outcomes...
October 14, 2016: Blood Purification
https://www.readbyqxmd.com/read/27641051/second-vascular-access-after-failure-of-the-first-fistula-in-the-elderly%C3%A2
#7
Tammy Hod, Alexander S Goldfarb-Rumyantzev, Bhanu K Patibandla, Akshita Narra, Robert S Brown
BACKGROUND: In patients with failure of an initial arteriovenous fistula (AVF), a subsequent vascular access is needed before hemodialysis (HD) initiation. METHODS: To assess the optimal access strategy after a failed AVF, we linked data from the US Renal Data System with Medicare claims data identifying 21,436 patients ≥ 67 years old who started HD between January 1, 2005, and December 31, 2008, with an AVF placed as their first predialysis access. Of the 10,568 subjects whose AVF failed, 1,796 patients had an AVF placed as a second access predialysis (AVF2 group) and 399 patients had an arteriovenous graft placed as a second access predialysis (AVG2 group)...
November 2016: Clinical Nephrology
https://www.readbyqxmd.com/read/27617144/actualizing-the-benefits-of-genomic-discovery-in-pediatric-nephrology
#8
REVIEW
Matthew G Sampson
The discovery of genetic variation associated with pediatric kidney disease has shed light on the biology underlying these conditions and, in some cases, has improved our clinical management of patients. We are challenged to continue the momentum of the genomic era in pediatric nephrology by identifying novel disease-associated genetic variation and translating these discoveries into clinical applications. This article reviews the diverse forms of genetic architecture that have been found to be associated with kidney diseases and traits...
March 2016: Journal of Pediatric Genetics
https://www.readbyqxmd.com/read/27600818/nutritional-support-in-the-tertiary-care-of-patients-affected-by-chronic-renal-insufficiency-report-of-a-step-wise-personalized-pragmatic-approach
#9
Adamasco Cupisti, Claudia D'Alessandro, Biagio Di Iorio, Anna Bottai, Claudia Zullo, Domenico Giannese, Massimiliano Barsotti, Maria Francesca Egidi
BACKGROUND: Dietary treatment is helpful in CKD patients, but nutritional interventions are scarcely implemented. The main concern of the renal diets is its feasibility with regards to daily clinical practice especially in the elderly and co-morbid patients. This study aimed to evaluate the effects of a pragmatic, step-wise, personalized nutritional support in the management of CKD patients on tertiary care. METHODS: This is a case-control study. It included 823 prevalent out-patients affected by CKD stage 3b to 5 not-in-dialysis, followed by tertiary care in nephrology clinics; 305 patients (190 males, aged 70 ± 12 years) received nutritional support (nutritional treatment Group, NTG); 518 patients (281 males, aged 73 ± 13 years) who did not receive any dietary therapy, formed the control group (CG)...
September 6, 2016: BMC Nephrology
https://www.readbyqxmd.com/read/27573725/podocyte-actin-dynamics-in-health-and-disease
#10
Luca Perico, Sara Conti, Ariela Benigni, Giuseppe Remuzzi
Genetic studies of hereditary forms of nephrotic syndrome have identified several proteins that are involved in regulating the permselective properties of the glomerular filtration system. Further extensive research has elucidated the complex molecular basis of the glomerular filtration barrier and clearly established the pivotal role of podocytes in the pathophysiology of glomerular diseases. Podocyte architecture is centred on focal adhesions and slit diaphragms - multiprotein signalling hubs that regulate cell morphology and function...
November 2016: Nature Reviews. Nephrology
https://www.readbyqxmd.com/read/27545637/-new-oral-anticoagulants-noac-in-nephrology
#11
Antonio Bellasi, Luca Di Lullo, Gianvincenzo Melfa, Claudio Minoretti, Carlo Ratti, Carlo Campana, Maurizio Volpi, Stefano Mangano, Biagio Di Iorio, Mario Cozzolino
The new or direct oral anticoagulants [new oral anticoagulants (NOAC) or direct oral anticoagulants (DOAC)] were launched in the Italian market in 2013. Although these compounds share common pharmacological indications with vitamin K antagonists (warfarin or acenocumarol), they have different mechanisms of action, do not require a constant anticoagulant monitoring but are more efficacious and safer than vitamin K antagonists. The use of these molecules (Dabigatran, Apixaban, Rivaroxaban, Betrixaban, Edoxaban) is constantly rising in daily practice...
July 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/27542858/cystatin-c-calculated-gfr-a-marker-of-early-renal-dysfunction-in-patients-with-neuropathic-bladder
#12
Pankaj P Dangle, Omar Ayyash, Audry Kang, Carlton Bates, Janelle Fox, Heidi Stephany, Glenn Cannon
OBJECTIVE: To asses if cystatin c calculated GFR can reveal CKD not detected by creatinine-based calculations in a larger prospective cohort of children with MMC. Wheel chair bound meningomyelocele (MMC) patients frequently have low muscle mass, and assessing renal deterioration based on creatinine based glomerular filtration rate is imprecise. MMC patients are also at risk for end stage renal disease. METHODS: Prospectively enrolled patients with MMC underwent annual serum creatinine and cystatin c testing...
August 16, 2016: Urology
https://www.readbyqxmd.com/read/27510453/supportive-care-comprehensive-conservative-care-in-end-stage-kidney-disease
#13
Fliss E M Murtagh, Aine Burns, Olivier Moranne, Rachael L Morton, Saraladevi Naicker
Comprehensive conservative (nondialytic) kidney care is widely recognized and delivered but until recently, has not been clearly defined. We provide a clear definition of comprehensive conservative care. This includes interventions to delay progression of kidney disease and minimize complications as well as detailed communication, shared decision making, advance care planning, and psychologic and family support. It does not include dialysis. Limited epidemiologic evidence from Australia and Canada indicates that, for every new person diagnosed with ESRD who receives dialysis or transplant, there is one new person who is managed conservatively (either actively or not)...
August 10, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27497527/establishing-core-outcome-domains-in-hemodialysis-report-of-the-standardized-outcomes-in-nephrology-hemodialysis-song-hd-consensus-workshop
#14
Allison Tong, Braden Manns, Brenda Hemmelgarn, David C Wheeler, Nicole Evangelidis, Peter Tugwell, Sally Crowe, Wim Van Biesen, Wolfgang C Winkelmayer, Donal O'Donoghue, Helen Tam-Tham, Jenny I Shen, Jule Pinter, Nicholas Larkins, Sajeda Youssouf, Sreedhar Mandayam, Angela Ju, Jonathan C Craig
Evidence-informed decision making in clinical care and policy in nephrology is undermined by trials that selectively report a large number of heterogeneous outcomes, many of which are not patient centered. The Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Initiative convened an international consensus workshop on November 7, 2015, to discuss the identification and implementation of a potential core outcome set for all trials in hemodialysis. The purpose of this article is to report qualitative analyses of the workshop discussions, describing the key aspects to consider when establishing core outcomes in trials involving patients on hemodialysis therapy...
August 3, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27496451/urinary-tract-infections-in-kidney-transplant-recipients-hospitalized-at-a-transplantation-and-nephrology-ward-1-year-follow-up
#15
J Gozdowska, M Czerwińska, Ł Chabros, G Młynarczyk, A Kwiatkowski, A Chmura, M Durlik
INTRODUCTION: The aim of this study was to investigate risk factors for urinary tract infections (UTI), the causative organisms of UTI and also their management and treatment. In addition, we evaluated the effects of UTI on renal graft function. METHODS: This analysis included 107 kidney transplant recipients (64% women) with a diagnosis of UTIs confirmed by positive results on urine culture. Type of pathogens, sensitivity to drugs, risk factors for infection, incidence of urosepsis, hospitalization period, treatment methods, and recurrence rates were analyzed...
June 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27469153/nephrology-in-africa-challenges-of-practice-in-resource-limited-environment
#16
Saraladevi Naicker
Chronic kidney disease (CKD), a major public health problem, is especially challenging for patients and healthcare personnel in Africa, a region with poor economic resources and a massive shortage of health-care workers. The burden of kidney disease is increased in poorly-resourced regions due to increased exposure to infections, poverty, poor access to healthcare, and genetic predisposition to kidney disease, contributing further to the problems when managing CKD and acute kidney injury. The vast majority of patients do not have access to renal replacement therapy...
2016: Clinical Nephrology
https://www.readbyqxmd.com/read/27422016/the-global-pediatric-nephrology-workforce-a-survey-of-the-international-pediatric-nephrology-association
#17
Dorey Glenn, Sophie Ocegueda, Meaghan Nazareth, Yi Zhong, Adam Weinstein, William Primack, Pierre Cochat, Maria Ferris
BACKGROUND: The global pediatric nephrology workforce is poorly characterized. The objectives of our study were to assess pediatric nephrologists' perceptions of the adequacy of the pediatric nephrology workforce, and understand regional challenges to fellow recruitment and job acquisition. Perceptions regarding optimal length of training and research requirements were also queried. METHODS: A 17-question web-based survey comprised of 14 close-ended and 3 open-ended questions was e-mailed to members of the International Pediatric Nephrology Association...
July 15, 2016: BMC Nephrology
https://www.readbyqxmd.com/read/27401689/pragmatic-trials-in-maintenance-dialysis-perspectives-from-the-kidney-health-initiative
#18
Laura M Dember, Patrick Archdeacon, Mahesh Krishnan, Eduardo Lacson, Shari M Ling, Prabir Roy-Chaudhury, Kimberly A Smith, Michael F Flessner
Pragmatic clinical trials are conducted under the real-world conditions of clinical care delivery. As a result, these trials yield findings that are highly generalizable to the nonresearch setting, identify interventions that are readily translatable into clinical practice, and cost less than trials that require extensive research infrastructures. Maintenance dialysis is a setting especially well suited for pragmatic trials because of inherently frequent and predictable patient encounters, highly granular and uniform data collection, use of electronic data systems, and delivery of care by a small number of provider organizations to approximately 90% of patients nationally...
October 2016: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/27389019/efficacy-of-the-essential-amino-acids-and-keto-analogues-on-the-ckd-progression-rate-in-real-practice-in-russia-city-nephrology-registry-data-for-outpatient-clinic
#19
Alexander Zemchenkov, Irina N Konakova
BACKGROUND: Renal replacement therapy (RRT) is growing by 10 % per year in Russia, but pre-dialysis care which can retard CKD progression and delay the start of RRT remains limited. We evaluate the effect of Essential Amino Acids and Keto-analogues (EAA/KA) on CKD progression. METHODS: The effect of low protein diet (LPD), supplemented by EAA/KA, on GFR slope changes between first and second treatment period (five sequential visits per period) in 96 patients withs CKD Stage 3B-5 was compared to GFR slope changes in the control group of 96 patients, randomly selected from matched (by gender, age, diagnosis and CKD Stage) cohort of 320 patients from the city Registry...
2016: BMC Nephrology
https://www.readbyqxmd.com/read/27378012/congenital-infundibulopelvic-stenosis-indications-for-intervention-surgical-technique-and-review-of-literature
#20
Christopher E Bayne, Craig A Peters
INTRODUCTION: Congenital infundibulopelvic stenosis (IFPS) is a rare renal dysmorphism marked by dilated calyces proximal to diminutive infundibulum and renal pelvises. The entity is theorized to exist on the spectrum of congenital obstructive renal diseases between ureteropelvic junction obstruction and multicystic dysplasia. OBJECTIVE: This case series sought to review and present the surgical management of three cases of IFPS with progressive renal insufficiency...
June 21, 2016: Journal of Pediatric Urology
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