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acute renal failure management

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https://www.readbyqxmd.com/read/29331397/persistent-hyperparathyroidism-as-a-risk-factor-for-long-term-graft-failure-the-need-to-discuss-indication-for-parathyroidectomy
#1
Maria Júlia Correia Lima Nepomuceno Araujo, Janaina Almeida Mota Ramalho, Rosilene Motta Elias, Vanda Jorgetti, William Nahas, Melani Custodio, Rosa M A Moysés, Elias David-Neto
BACKGROUND: Although a successful kidney transplant (KTx) improves most of the mineral and bone disorders (MBD) produced by chronic kidney disease (CKD), hyperparathyroidism may persist (pHPT). Current guidelines recommend parathyroidectomy if serum parathormone is persistently elevated 1 year after KTx, because pHPT has been recently associated with poor graft outcomes. However, whether patients with pHPT and adequate renal function are at risk for long-term graft failure is unknown...
January 10, 2018: Surgery
https://www.readbyqxmd.com/read/29331008/atypical-presentation-of-rickettsial-spotted-fever
#2
Uday Prabhakar, Anup Singh
Acute febrile illness is a common entity in tropics and often is challenging due a host of pathogenic bacteria, viruses and fungi. Extensive work up is required for better management. Rickettsiosis is uncommon and hence comes lower down in the differentials of multiorgan failure being superseded by the more common diseases as malaria, enteric fever and Dengue. We document a case of young male presenting with high grade fever, multiorgan dysfunction (hepatic, renal, neurological and respiratory involvement), conjunctival suffusion, retiform rash and without lymphadenopathy...
October 2017: Journal of Ayub Medical College, Abbottabad: JAMC
https://www.readbyqxmd.com/read/29314257/contemporary-management-and-outcomes-of-acute-type-a-aortic-dissection-an-analysis-of-the-sts-adult-cardiac-surgery-database
#3
Teng C Lee, Zachary Kon, Faisal H Cheema, Maria V Grau-Sepulveda, Brian Englum, Sunghee Kim, Paramita S Chaudhuri, Vinod H Thourani, Gorav Ailawadi, G Chad Hughes, Matthew L Williams, J Matthew Brennan, Lars Svensson, James S Gammie
PURPOSE: Management of acute type A aortic dissection (AAAD) is challenging and operative strategies are varied. We used the STS Adult Cardiac Surgery Database (STS ACSD) to describe contemporary surgical strategies and outcomes for AAAD. METHODS: Between July 2011 and September 2012, 2982 patients with AAAD underwent operations at 640 centers in North America. RESULTS: In this cohort, median age was 60 years old, 66% were male, and 80% had hypertension...
January 4, 2018: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/29313560/surgical-closure-of-patent-ductus-arteriosus-in-extremely-low-birth-weight-infants-less-than-750-grams
#4
Tomasz Stankowski, Sleiman Sebastian Aboulhassan, Dirk Fritzsche, Marcin Misterski, Jakub Marczak, Anna Szymańska, Lukasz Szarpak, Cyprian Augustyn, Romuald Cichoń, Bartłomiej Perek
BACKGROUND: Patent ductus arteriosus (PDA) occurs more frequently in premature infants. Depending on the degree of prematurity, these children often have other serious comorbidities that could significantly impact on surgical outcome. AIM: This study aimed to evaluate clinical results of the surgical ligation of PDA in extremely low body weight preterm infants with birth weight below 750 grams and to identify risk factors of mortality. METHODS: A total of 31 preterm infants with birth weight below 750 grams and significant PDA were operated between 2006 and 2016 through posterolateral thoracotomy (n=16) or with the use of video-assisted thoracoscopic (VATS) method (n = 15)...
January 9, 2018: Kardiologia Polska
https://www.readbyqxmd.com/read/29306670/multivessel-disease-in-patients-over-75years-old-with-st-elevated-myocardial-infarction-current-management-strategies-and-related-clinical-outcomes-in-the-estrofa-mi-75-nation-wide-registry
#5
Jose M de La Torre Hernandez, Joan A Gomez Hospital, Jose A Baz, Salvatore Brugaletta, Armando Perez de Prado, Jose A Linares, Ramón Lopez Palop, Belen Cid, Tamara Garcia Camarero, Alejandro Diego, Hipolito Gutierrez, Jose A Fernandez Diaz, Juan Sanchis, Fernando Alfonso, Roberto Blanco, Javier Botas, Javier Navarro Cuartero, Jose Moreu, Francisco Bosa, Jose M Vegas, Jaime Elizaga, Antonio L Arrebola, Felipe Hernandez, Neus Salvatella, Marta Monteagudo, Alfredo Gomez Jaume, Xavier Carrillo, Roberto Martin Reyes, Fernando Lozano, Jose R Rumoroso, Leire Andraka, Antonio J Dominguez
BACKGROUND: In elderly patients with ST elevated myocardial infarction (STEMI) and multivessel disease (MVD the outcomes related with different revascularization strategies are not well known. METHODS: Subgroup-analysis of a nation-wide registry of primary angioplasty in the elderly (ESTROFA MI+75) with 3576 patients over 75years old from 31 centers. Patients with MVD were analyzed to describe treatment approaches and 2years outcomes. RESULTS: Of 1830 (51%) with MVD, 847 (46%) underwent multivessel revascularization either in acute (51%), staged (44%) or both procedures (5%)...
December 6, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/29302827/colonic-perforation-due-to-severe-cytomegalovirus-disease-in-granulomatosis-with-polyangiitis-after-immunosuppression
#6
REVIEW
Alessandra Soriano, Nazareno Smerieri, Stefano Bonilauri, Loredana De Marco, Alberto Cavazza, Carlo Salvarani
Granulomatosis with polyangiitis (GPA) is a small-vessel necrotizing granulomatous vasculitis typically involving upper airways, lungs, and kidneys, which may lead to end-organ damage and life-threatening complications. Major infections during GPA course represent a considerable concern in the management of the disease. Cytomegalovirus (CMV) infection and disease are rare but significant complications in the course of GPA being associated with high morbidity and mortality rates. Colonic perforation due to CMV colitis is exceedingly rare and has so far almost exclusively been documented in HIV, renal transplant, and systemic lupus erythematosus patients...
January 4, 2018: Clinical Rheumatology
https://www.readbyqxmd.com/read/29297082/enhancing-recovery-from-sepsis-a-review
#7
REVIEW
Hallie C Prescott, Derek C Angus
Importance: Survival from sepsis has improved in recent years, resulting in an increasing number of patients who have survived sepsis treatment. Current sepsis guidelines do not provide guidance on posthospital care or recovery. Observations: Each year, more than 19 million individuals develop sepsis, defined as a life-threatening acute organ dysfunction secondary to infection. Approximately 14 million survive to hospital discharge and their prognosis varies. Half of patients recover, one-third die during the following year, and one-sixth have severe persistent impairments...
January 2, 2018: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29289391/acute-diverticulitis-in-renal-transplant-patients-should-we-treat-them-differently
#8
Jeremy Sugrue, Joanna Lee, Christina Warner, Sany Thomas, Ivo Tzvetanov, Winnie Mar, Anders Mellgren, Johan Nordenstam
BACKGROUND: Current guidelines suggest that transplant patients with acute diverticulitis should be managed aggressively with early operative intervention to reduce morbidity and mortality. This study compared the treatment choices and clinical outcomes between renal transplant patients and immunocompetent patients with acute diverticulitis. METHODS: A retrospective review was performed of all patients who were admitted with acute diverticulitis between 2002 and 2015 at a single academic institution...
December 27, 2017: Surgery
https://www.readbyqxmd.com/read/29289268/rhabdomyolysis-associated-acute-kidney-injury-with-normal-creatine-phosphokinase
#9
Faisal Kamal, Lindsay Snook, Jagannath H Saikumar
Rhabdomyolysis is a syndrome characterized by the breakdown of skeletal muscle and leakage of intracellular myocyte contents, such as creatine phosphokinase (CPK) and myoglobin, into the interstitial space and plasma resulting in acute kidney injury (AKI). Elevated CPK of at least 5 times the upper limit of normal is an important diagnostic marker of Rhabdomyolysis. We present a case of rhabdomyolysis with severe AKI with a normal CPK at presentation. A 32-year-old man presented with acute respiratory failure and AKI after an overdose of recreational drugs...
January 2018: American Journal of the Medical Sciences
https://www.readbyqxmd.com/read/29284433/adaptation-of-the-who-maternal-near-miss-tool-for-use-in-sub-saharan-africa-an-international-delphi-study
#10
Abera K Tura, Jelle Stekelenburg, Sicco A Scherjon, Joost Zwart, Thomas van den Akker, Jos van Roosmalen, Sanne J Gordijn
BACKGROUND: Assessments of maternal near miss (MNM) are increasingly used in addition to those of maternal mortality measures. The World Health Organization (WHO) has introduced an MNM tool in 2009, but this tool was previously found to be of limited applicability in several low-resource settings. The aim of this study was to identify adaptations to enhance applicability of the WHO MNM tool in sub-Saharan Africa. METHODS: Using a Delphi consensus methodology, existing MNM tools were rated for applicability in sub-Saharan Africa over a series of three rounds...
December 29, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29274759/acute-myocardial-infarction-in-patients-with-paraplegia-characteristics-management-and-outcomes
#11
Susan Feng Lu, Lauren Xiaoyuan Lu, Sidney C Smith, Xuming Dai
BACKGROUND: Cardiovascular disease has become a leading cause of death for patients with paraplegia. Acute myocardial infarction in patients with paraplegia has not been described in literature. Evidence gathered from studies of acute myocardial infarction in ambulating individuals may not be directly applicable to paraplegic patients. This study investigates clinical features, management strategies, and outcomes of acute myocardial infarction in patients with paraplegia. METHODS: Acute myocardial infarction in patients with or without paraplegia was identified in the New York State Inpatient Database between 2007 and 2013...
December 21, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/29238427/hiv-associated-nephropathy-in-africa-pathology-clinical-presentation-and-strategy-for-prevention
#12
REVIEW
Nazik Elmalaika Husain, Mohamed H Ahmed, Ahmed O Almobarak, Sufian K Noor, Wadie M Elmadhoun, Heitham Awadalla, Clare L Woodward, Dushyant Mital
The human immunodeficiency virus (HIV) infection can lead to progressive decline in renal function known as HIV-associated nephropathy (HIVAN). Importantly, individuals of African ancestry are more at risk of developing HIVAN than their European descent counterparts. An in-depth search on Google Scholar, Medline and PubMed was conducted using the terms "HIVAN" and "pathology and clinical presentation", in addition to "prevalence and risk factors for HIVAN", with special emphasis on African countries for any articles published between 1990 and 2017...
January 2018: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/29232246/the-role-of-fdg-pet-in-diabetic-myonecrosis-a-rare-and-underrecognized-complication-of-diabetes
#13
Guillaume Chaussé, Gad Abikhzer
A 66-year-old man with poorly controlled type 2 diabetes was admitted for acute bilateral calf pain in the context of coronary artery disease, chronic renal failure, and peripheral neuropathy. Lower-extremity Doppler ultrasound excluded deep vein thrombosis. FDG-PET was performed to exclude a suspected infection because of elevated white blood cells and inflammatory markers but normal creatinine kinase levels. PET scan demonstrated intense bilateral calf muscle and left thigh muscle uptake, which in combination with the patient's history was consistent with diabetic myonecrosis, a rare end-stage complication of diabetes...
December 11, 2017: Clinical Nuclear Medicine
https://www.readbyqxmd.com/read/29230546/management-and-predictors-of-outcome-in-unselected-patients-with-cardiogenic-shock-complicating-acute-st-segment-elevation-myocardial-infarction-results-from-the-bremen-stemi-registry
#14
Tina Backhaus, Andreas Fach, Johannes Schmucker, Eduard Fiehn, Daniela Garstka, Janina Stehmeier, Rainer Hambrecht, Harm Wienbergen
INTRODUCTION: Patients with ST-segment elevation myocardial infarction (STEMI) and consecutive cardiogenic shock (CS) represent a challenge in clinical practice. Only few 'real-world' data on therapeutic management and outcome exist. METHODS: The present analysis focuses on changes of clinical management of STEMI-patients with CS and analyzes predictors of outcome using the Bremen-STEMI registry. RESULTS: Out of 7865 patients with STEMI, 981 patients (13%) presented with CS...
December 11, 2017: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/29228499/high-dose-intravenous-immunoglobulins-for-the-treatment-of-dermatological-autoimmune-diseases
#15
Jochen H O Hoffmann, Alexander H Enk
Based on their immunomodulatory properties, high-dose intravenous immunoglobulins (IVIGs) are successfully used in the treatment of various dermatological autoimmune diseases, in particular pemphigus vulgaris and dermatomyositis. In autoimmune bullous diseases, IVIGs can be used in an adjuvant setting (second- or third-line therapy) once combined immunosuppressive regimens have failed. In dermatomyositis, IVIGs may already be employed as an adjuvant second-line therapy after failure of corticosteroid monotherapy...
December 2017: Journal der Deutschen Dermatologischen Gesellschaft, Journal of the German Society of Dermatology: JDDG
https://www.readbyqxmd.com/read/29225802/effective-immunosuppressive-management-with-belatacept-and-eculizumab-in-post-transplant-ahus-due-to-a-homozygous-deletion-of-cfhr1-cfhr3-and-the-presence-of-cfh-antibodies
#16
Johannes Münch, Anette Bachmann, Maik Grohmann, Christof Mayer, Michael Kirschfink, Tom H Lindner, Carsten Bergmann, Jan Halbritter
Atypical haemolytic uraemic syndrome (aHUS) may clinically present as acute renal graft failure resulting from excessive activation of the complement cascade. While mutations of complement-encoding genes predispose for aHUS, it is generally thought to require an additional insult (e.g. drugs) to trigger and manifest the full-blown clinical syndrome. Calcineurin inhibitors (CNIs) used for immunosuppression act as potential triggers, especially in the post-transplantation setting. Therefore, CNI-free immunosuppressive regimens may be beneficial...
December 2017: Clinical Kidney Journal
https://www.readbyqxmd.com/read/29222218/fat-embolism-a-rare-cause-of-perioperative-renal-transplant-dysfunction
#17
Jemima Scott, Neil Collin, Richard Baker, Rommel Ravanan
Fat embolism is a recognised complication of bony injury and orthopaedic surgery, commonly involving the long bones and pelvis. We report on the case of a 68-year-old renal transplant recipient who developed acute kidney injury following surgical stabilisation of metastatic carcinoma of the acetabulum and replacement of the proximal femur. A CT renal angiogram demonstrated a large fat embolus in the inferior vena cava (IVC) and left iliac veins below the level of IVC filter, with impaired renal perfusion. The risks of open or endovascular lipothrombectomy were felt to outweigh the potential benefits...
December 7, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29217372/acute-peritoneal-dialysis-in-neonatal-intensive-care-unit-an-8-year-experience-of-a-referral-hospital
#18
Aslihan Kara, Metin Kaya Gurgoze, Mustafa Aydin, Erdal Taskin, Unal Bakal, Aysen Orman
BACKGROUND: The aim of present study was to evaluate the indications, complications and outcomes of acute peritoneal dialysis (APD) in neonates at a referral university hospital during the previous 8 years. METHODS: This retrospective analysis included a total of 52 newborn infants who underwent APD in a neonatal intensive care unit between January 2008 and March 2016. Demographic, clinical, laboratory and microbiological data were extracted from patients' medical files...
November 16, 2017: Pediatrics and Neonatology
https://www.readbyqxmd.com/read/29217087/evolution-of-simplified-frozen-elephant-trunk-repair-for-acute-debakey-type-i-dissection-midterm-outcomes
#19
Eric E Roselli, Jay J Idrees, Faisal G Bakaeen, Michael Z Tong, Edward G Soltesz, Stephanie Mick, Douglas R Johnston, Mathew J Eagleton, Venu Menon, Lars G Svensson
BACKGROUND: A modified technique for frozen elephant trunk (FET) repair of acute DeBakey type I dissection has evolved. Procedural modifications are described and midterm outcomes evaluated. METHODS: From 2009 to 2016, 72 patients with DeBakey type I dissection underwent emergency simplified FET. Mean age was 59 ± 15 years. Presentation included malperfusion (n = 22, 31%), rupture (n = 12, 16%), and aortic insufficiency (n = 42, 58%). Concomitant procedures included valve replacement (n = 9), root replacement (n = 11; valve sparing n = 6), cusp repair (n = 11), and valve resuspension (n = 21)...
December 4, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29201964/intravenous-lidocaine-compared-to-fentanyl-in-renal-colic-pain-management-a-randomized-clinical-trial
#20
Hassan Motamed, Mohammadreza Maleki Verki
Introduction: Using alpha blockers such as intravenous (IV) lidocaine has been deemed effective in controlling acute pain. Therefore, the current study was designed with the aim of evaluating the efficiency of IV lidocaine in comparison to IV fentanyl in pain management of patients with renal colic in emergency department (ED). Methods: In this double blind clinical trial, 18-65 year old patients that presented to ED with colicky flank pain and met the inclusion criteria of the study were allocated to either lidocaine or fentanyl group using block randomization and compared regarding pain severity 5, 10, 15, and 30 minutes after drug administration...
2017: Emergency (Tehran, Iran)
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