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Diabetic nephrology

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...
October 5, 2016: JAAPA: Official Journal of the American Academy of Physician Assistants
Yi-Chia Su, Chih-Chien Wu
A 54-year-old woman presented at the emergency department after experiencing lower limb weakness and bilateral ankle pain for 2 days. She had a history of type 2 diabetes mellitus, diabetes mellitus nephropathy with chronic kidney disease, and chronic gouty arthritis. She had received 0.6 mg colchicine orally once or twice daily for 8 months. Four days prior to her emergency department visit, she was discharged from our nephrology ward, where she had been admitted because of a urinary tract infection. During hospitalization, she was treated with intravenous cefazolin for 7 days...
December 2015: Drug Saf Case Rep
L V Kroth, F F Barreiro, D Saitovitch, M A Traesel, D O d'Avila, C E Poli-de-Figueiredo
BACKGROUND: The Nephrology Unit at São Lucas Hospital, a University Hospital in Southern Brazil, has recently reached 35 years since its first kidney transplant. Few centers in the area have made a longitudinal analysis of processes, problems, grafts, and patient survival changes along this time. METHODS: A single-center, retrospective study was performed. Data were separated into different eras, based on the nature of immunosuppression used: pre-cyclosporine (1978-1986), cyclosporine (1987-1997), mycophenolate introduction (1998-2002), new immunosuppressant drugs (2003-2007), and the current period (2008-2013)...
September 2016: Transplantation Proceedings
Alessandro Gasparini, Marie Evans, Josef Coresh, Morgan E Grams, Olof Norin, Abdul R Qureshi, Björn Runesson, Peter Barany, Johan Ärnlöv, Tomas Jernberg, Björn Wettermark, Carl G Elinder, Juan-Jesüs Carrero
BACKGROUND: Chronic kidney disease (CKD) is common, but the frequency of albuminuria testing and referral to nephrology care has been difficult to measure. We here characterize CKD prevalence and recognition in a complete healthcare utilization cohort of the Stockholm region, in Sweden. METHODS: We included all adult individuals (n = 1 128 058) with at least one outpatient measurement of IDMS-calibrated serum creatinine during 2006-11. Estimated glomerular filtration rate (eGFR) was calculated via the CKD-EPI equation and CKD was solely defined as eGFR <60 mL/min/1...
October 13, 2016: Nephrology, Dialysis, Transplantation
Sahir Kalim, Eugene P Rhee
The high-throughput, high-resolution phenotyping enabled by metabolomics has been applied increasingly to a variety of questions in nephrology research. This article provides an overview of current metabolomics methodologies and nomenclature, citing specific considerations in sample preparation, metabolite measurement, and data analysis that investigators should understand when examining the literature or designing a study. Furthermore, we review several notable findings that have emerged in the literature that both highlight some of the limitations of current profiling approaches, as well as outline specific strengths unique to metabolomics...
September 28, 2016: Kidney International
Hannelore Sprenger-Mähr, Emanuel Zitt, Karl Lhotta
INTRODUCTION: The number of patients suffering from acute kidney injury requiring dialysis (AKI-D) is increasing. Whereas causes and outcome of AKI-D in the intensive care unit (ICU) are described extensively, few data exist about AKI-D patients treated outside the ICU. Aim of this study was to identify the causes of AKI-D, determine in-depth the comorbid conditions and outcome of this particular patient group and identify possibilities for its prevention. METHODS: We retrospectively studied all AKI-D patients treated outside the ICU in a single nephrology referral center between January 2010 and June 2015...
2016: PloS One
Monica Cortinovis, Norberto Perico, Giuseppe Remuzzi
The randomized controlled trial (RCT) is the cornerstone upon which clinical decision-making is based. Pivotal RCTs in the nephrology area efficiently demonstrated the renoprotective effects of treatment with renin-angiotensin system inhibitors in patients with diabetic and non-diabetic proteinuric nephropathies. However, there is concern about the increasing cost, complexity and duration of clinical studies. Moreover, recent large RCTs addressing key issues for patients with renal disease failed to achieve definitive conclusions mainly due to critical flaws in the investigational strategies, including the adoption of excessive/fixed doses of the study medications, inappropriate use of the placebo-controlled design, enrollment of low-risk individuals, poor reporting of adverse events or unreliable evaluation of renal function...
September 20, 2016: Nephron
Benja Ramilitiana, Mihary Dodo, Henintsoa Nirina Rakotoarimanga, Rado Lalao Randriamboavonjy, Willy Franck Randriamarotia
The knowledge of normale renal sizes specific for each individual and for any ethnicity, allows diagnostic and therapeutic medical decision. For a low-income country such as Madagascar, ultrasound is an ideal tool for this purpose. This study aims to collect data on renal dimensions and to seek the correlation between these data and the demographic and anthropometric parameters in Malagasies. This is a retrospective study of 200 non-diabetic patients without chronic kidney disease, spanning 3 years, conducted in the Nephrology Department of Befelatanana Hospital, Antananarivo...
2016: Pan African Medical Journal
Martin Ritt, Karl-Günter Gaßmann, Cornel Christian Sieber
Frailty is a major health burden in an aging society. It constitutes a clinical state of reduced physiological reserves that is associated with a diminished ability to withstand internal and external stressors. Frail patients have an increased risk for adverse clinical outcomes, such as mortality, readmission to hospital, institutionalization and falls. Of further clinical interest, frailty might be at least in part reversible in some patients and subject to preventive strategies. In daily clinical practice older patients with a complex health status, who are mostly frail or at least at risk of developing frailty, are frequently cared for by geriatricians...
October 2016: Zeitschrift Für Gerontologie und Geriatrie
Marco Cascella
Professor Giuseppe Moscati (1880-1927) was canonized by the Catholic Church in 1987. This act recognized the extraordinary qualities of a doctor who, considering his work as a "sublime mission", dedicated his life to helping the sick. The fame of the "Holy doctor" or "doctor of the poor", as people called him, was soon widespread and, immediately after his death, made him the subject of several biographies. These treatises, mainly written by religious hagiographers, have little analyzed Moscati as a doctor and scientist, or, in rare cases, privileged the description of his medical career, touching only marginally salient aspects of his work as a scientist and researcher...
August 2016: Acta Medico-historica Adriatica: AMHA
Vincenzo Bellizzi, Giuseppe Conte, Silvio Borrelli, Adamasco Cupisti, Luca De Nicola, Biagio R Di Iorio, Gianfranca Cabiddu, Marcora Mandreoli, Ernesto Paoletti, Giorgina B Piccoli, Giuseppe Quintaliani, Maura Ravera, Domenico Santoro, Serena Torraca, Roberto Minutolo
This position paper of the study group "Conservative treatment of Chronic Kidney Disease-CKD" of the Italian Society of Nephrology addresses major practical, unresolved, issues related to the conservative treatment of chronic renal disease. Specifically, controversial topics from everyday clinical nephrology practice which cannot find a clear, definitive answer in the current literature or in nephrology guidelines are discussed. The paper reports the point of view of the study group. Concise and practical advice is given on several common issues: renal biopsy in diabetes; dual blockade of the renin-angiotensin-aldosterone system (RAAS); management of iron deficiency; low protein diet; dietary salt intake; bicarbonate supplementation; treatment of obesity; the choice of conservative therapy vs...
August 27, 2016: Journal of Nephrology
Lobna Zouari, Sana Omri, Sahar Turki, Manel Maâlej, Nada Charfi, Jihène Ben Thabet, Hichem Mahfoudh, Jamil Hachicha, Mohamed Maâlej
BACKGROUND: The chronic hemodialysis imposes various limitations on patients that may affect their quality of life. However, Tunisian studies on this matter remain scarce. AIMS: To assess the quality of life among hemodialysis patients and to identify the factors influencing their quality of life. METHODS: We performed a cross-sectional study which included 71 outpatients, during the month of January 2013, in the department of Nephrology at Hedi Chaker Sfax university hospital in Tunisia...
January 2016: La Tunisie Médicale
Andrew Schreiner, Kit Simpson
BACKGROUND: Primary care referrals to specialty physicians play an integral role in patient care and health care costs. Multiple factors play into the primary care physician's decision to refer, including comfort managing particular conditions. As the burden of chronic disease climbs, the relationship between patients, primary care physicians and specialists in accurately diagnosing, managing and treating chronic conditions needs clarity. The objective of this study is to assess the relationship between specialty physician involvement and the care of three chronic conditions: diabetes mellitus (DM), chronic kidney disease (CKD) and systemic lupus erythematosus (SLE)...
August 15, 2016: Journal of Evaluation in Clinical Practice
Wouter De Corte, Annemieke Dhondt, Raymond Vanholder, Jan De Waele, Johan Decruyenaere, Veerle Sergoyne, Joke Vanhalst, Stefaan Claus, Eric A J Hoste
BACKGROUND: In intensive care unit (ICU) patients, acute kidney injury treated with renal replacement therapy (AKI-RRT) is associated with adverse outcomes. The aim of this study was to evaluate variables associated with long-term survival and kidney outcome and to assess the composite endpoint major adverse kidney events (MAKE; defined as death, incomplete kidney recovery, or development of end-stage renal disease treated with RRT) in a cohort of ICU patients with AKI-RRT. METHODS: We conducted a single-center, prospective observational study in a 50-bed ICU tertiary care hospital...
2016: Critical Care: the Official Journal of the Critical Care Forum
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
Ebun Ladipo Bamgboye
Chronic kidney disease (CKD) is a significant cause of morbidity and mortality in sub-Saharan Africa. This, along with other noncommunicable diseases like hypertension, diabetes, and heart diseases, poses a double burden on a region that is still struggling to cope with the scourge of communicable diseases like malaria, tuberculosis, HIV, and more recently Ebola. Causes of CKD in the region are predominantly glomerulonephritis and hypertension, although type 2 diabetes is also becoming a significant cause as is the retroviral disease...
August 10, 2016: Clinical Nephrology
Guillermo Rosa-Diez, María Gonzalez-Bedat, Alejandro Ferreiro, Guillermo García-García, Juan Fernandez-Cean, Walter Douthat
INTRODUCTION: End-stage renal disease (ESRD) represents a major challenge for Latin America (LA). Epidemiological information needed to assist in the development of ESRD care in the region. The Latin American Dialysis and Renal Transplant Registry (RLADTR), has published several reports and its continuity has implied a sustained effort of the entire LA Nephrology community. This paper summarizes the results corresponding to year 2012. METHODS: Our methods have been reported previously...
August 10, 2016: Clinical Nephrology
Aline C Q Leão, Paulo R Menezes, Maura S Oliveira, Anna S Levin
BACKGROUND: It has been challenging to determine the true clinical impact of Acinetobacter spp., due to the predilection of this pathogen to colonize and infect critically ill patients, who often have a poor prognosis. The aim of this study was to assess whether Acinetobacter spp. bacteremia is associated with lower survival compared with bacteremia caused by other pathogens in critically ill patients. METHODS: This study was performed at Hospital das Clínicas, University of São Paulo, Brazil...
2016: BMC Infectious Diseases
Allison Tong, Klemens Budde, John Gill, Michelle A Josephson, Lorna Marson, Timothy L Pruett, Peter P Reese, David Rosenbloom, Lionel Rostaing, Anthony N Warrens, Germaine Wong, Jonathan C Craig, Sally Crowe, Tess Harris, Brenda Hemmelgarn, Braden Manns, Peter Tugwell, Wim Van Biesen, David C Wheeler, Wolfgang C Winkelmayer, Nicole Evangelidis, Benedicte Sautenet, Martin Howell, Jeremy R Chapman
BACKGROUND: Although advances in treatment have dramatically improved short-term graft survival and acute rejection in kidney transplant recipients, long-term graft outcomes have not substantially improved. Transplant recipients also have a considerably increased risk of cancer, cardiovascular disease, diabetes, and infection, which all contribute to appreciable morbidity and premature mortality. Many trials in kidney transplantation are short-term, frequently use unvalidated surrogate endpoints, outcomes of uncertain relevance to patients and clinicians, and do not consistently measure and report key outcomes like death, graft loss, graft function, and adverse effects of therapy...
June 2016: Transplantation Direct
Daniel Murphy, Charles E McCulloch, Feng Lin, Tanushree Banerjee, Jennifer L Bragg-Gresham, Mark S Eberhardt, Hal Morgenstern, Meda E Pavkov, Rajiv Saran, Neil R Powe, Chi-Yuan Hsu
Background: Trends in the prevalence of chronic kidney disease (CKD) are important for health care policy and planning. Objective: To update trends in CKD prevalence. Design: Repeated cross-sectional study. Setting: NHANES (National Health and Nutrition Examination Survey) for 1988 to 1994 and every 2 years from 1999 to 2012. Participants: Adults aged 20 years or older. Measurements: Chronic kidney disease (stages 3 and 4) was defined as an estimated glomerular filtration rate (eGFR) of 15 to 59 mL/min/1...
October 4, 2016: Annals of Internal Medicine
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