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Continuous renal

Clifford D Miles, Scott Westphal, AnnMarie Liapakis, Richard Formica
Purpose: The number of simultaneous liver-kidney transplants (SLKT) performed in the USA has been rising. The Organ Procurement and Transplantation Network implemented a new policy governing SLKT that specifies eligibility criteria for candidates to receive a kidney with a liver, and creates a kidney waitlist "safety net" for liver recipients with persistent renal failure after transplant. This review explores potential impacts for liver patients and the kidney waitlist. Recent Findings: Factors that have contributed to the rise in SLKT including Model for End-stage Liver Disease (MELD)-based allocation, regional sharing for high MELD candidates, and the rising incidence of non-alcoholic steatohepatitis will continue to increase the number of liver transplant candidates with concurrent renal insufficiency...
2018: Current Transplantation Reports
Gabor Erdoes, Dominik E Uehlinger, Beatrice Kobel, Monika P Stucki, Roland Wiest, Frank Stueber, Niklaus Fankhauser, Stephan M Jakob, Joerg C Schefold
BACKGROUND: Microembolism is a frequent pathological event during extracorporeal renal replacement therapy (RRT). Some previous data indicate that microemboli are generated in patients who are undergoing RRT and that these may contribute to increased cerebrovascular and neurocognitive morbidity in patients with end-stage renal disease. The current trial aims to quantify the microembolic load and respective qualitative composition that effectively reaches the intracerebral circulation in critically ill patients treated with different RRT modalities for acute kidney injury (AKI)...
March 21, 2018: Trials
Ping Jiang, Dufang Ma, Xue Wang, Yongcheng Wang, Yuxin Bi, Jinlong Yang, Xuebing Wang, Xiao Li
Low-grade pro-inflammatory state and leptin resistance are important underlying mechanisms that contribute to obesityassociated hypertension. We tested the hypothesis that Astragaloside IV (As IV), known to counteract obesity and hypertension, could prevent obesity-associated hypertension by inhibiting pro-inflammatory reaction and leptin resistance. High-fat diet (HFD) induced obese rats were randomly assigned to three groups: the HFD control group (HF con group), As IV group, and the As IV + α-bungaratoxin (α-BGT) group (As IV+α-BGT group)...
March 20, 2018: Molecules and Cells
Robert P Runner, Amanda Mener, Thomas L Bradbury
A 58-year-old male presented with native joint septic arthritis of the hip and osteomyelitis. After treatment with an articulating antibiotic spacer, he developed acute renal failure requiring dialysis. He continued to have elevated serum tobramycin levels exclusively from the antibiotic spacer elution as no intravenous tobramycin was used. Subsequent explantation was required to correct his renal failure. Although renal failure after antibiotic impregnated cement placement is rare, the risk of this potential complication should be considered preoperatively and in the postoperative management of these patients...
March 2018: Arthroplasty Today
Po-Ya Chang, Li-Nien Chien, Chyi-Huey Bai, Yuh-Feng Lin, Hung-Yi Chiou
Purpose: Effective management for type 2 diabetes mellitus (DM) can slow the progression of kidney outcomes and reduce hospital admissions. Better continuity of care (COC) was found to improve patients' adherence and self-management. This study examined the associations between COC, hospitalization, and end-stage renal disease (ESRD) in DM patients. Patients and methods: In the cohort study, data from 1996 to 2012 were retrieved from the Longitudinal Health Insurance Database, using inverse probability weighted analysis...
2018: Therapeutics and Clinical Risk Management
L Ormesher, E D Johnstone, E Shawkat, A Dempsey, C Chmiel, E Ingram, L E Higgins, J E Myers
OBJECTIVE: To evaluate the use of plasma Placental Growth Factor (PlGF), recommended by the recent NICE guidance, in women with suspected pre-eclampsia (PE) and/or fetal growth restriction (FGR). STUDY DESIGN: Non-randomised prospective clinical evaluation study in high-risk antenatal clinics in a tertiary maternity unit. METHODS: PlGF testing was performed in addition to routine clinical assessment in 260 women >20 weeks' gestation with chronic disease (hypertension, renal disease ± diabetes) with a change in maternal condition or in women with suspected FGR to determine the impact on clinical management...
March 13, 2018: Pregnancy Hypertension
Ulkem Kocoglu Barlas, Hasan Serdar Kıhtır, Nilufer Goknar, Melike Ersoy, Nihal Akcay, Esra Sevketoglu
BACKGROUND: Hemolytic uremic syndrome (HUS) is a clinical syndrome characterized by hemolytic anemia, thrombocytopenia, and acute kidney injury. Atypical hemolytic uremic syndrome (aHUS) is a devastating disease with significant mortality and high risk of progression to end-stage kidney disease. It is mostly caused by dysregulation of the alternative complement pathway. Cobalamin C (Cbl C) defect is a genetic disorder of cobalamin metabolism and is a rare cause of HUS. CASE-DIAGNOSIS/TREATMENT: We present a 6-month-old male infant who was admitted to the pediatric intensive care unit (PICU) due to restlessness, severe hypertension, anemia, respiratory distress, and acute kidney injury...
March 20, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Jing Du, Ying Wang, Yan-Chun Li, Tong-Tong Wang, Yong-Lie Zhou, Zhen-Hua Ying
Systemic lupus erythematosus (SLE) is an autoimmune disease that affects many organs, but multisystem dysfunction is rare. Here, we report a case of a 29-year-old woman who was initially diagnosed with SLE complications including lupus nephritis, lupus encephalopathy, renal hypertension, thrombocytopenia, anaemia and hyperkalaemia. She recovered following treatment with high dose methylprednisolone, intravenous immunoglobulin (IVIG) and continuous renal replacement therapy (CRRT). However, a few days after hospital discharge, she developed gastrointestinal bleeding...
January 1, 2018: Journal of International Medical Research
Gaëlle Cheisson, Sophie Jacqueminet, Emmanuel Cosson, Carole Ichai, Anne-Marie Leguerrier, Bogdan Nicolescu-Catargi, Alexandre Ouattara, Igor Tauveron, Paul Valensi, Dan Benhamou
Follow on from continuous intravenous administration of insulin with an electronic syringe (IVES) is an important element in the postoperative management of a diabetic patient. The basal-bolus scheme is the most suitable taking into account the nutritional supply and variable needs for insulin, reproducing the physiology of a normal pancreas: (i) slow (long-acting) insulin (= basal) which should immediately take over from IVES insulin simulating basal secretion; (ii) ultra-rapid insulin to simulate prandial secretion (= bolus for the meal); and (iii) correction of possible hyperglycaemia with an additional ultra-rapid insulin bolus dose...
March 16, 2018: Anaesthesia, Critical Care & Pain Medicine
Jingyuan Xie, Jicheng Lv, Weiming Wang, Guisen Li, Zhangsuo Liu, Hongyu Chen, Feifei Xu, Jing Sun, Yan Ouyang, Xiaoyan Zhang, Meng Yang, Manman Shi, Wen Zhang, Hong Ren, Krzysztof Kiryluk, Hong Zhang, Nan Chen
BACKGROUND: The clinical course of immunoglobulin A (IgA) nephropathy (IgAN) is highly variable, making it difficult to predict which patients are at risk for rapid progression. The aim of this study was to develop and validate a kidney failure risk prediction equation for adults with IgAN. STUDY DESIGN: Multicenter retrospective cohort study of 2,155 Chinese patients with IgAN. CANDIDATE PREDICTORS: Clinical and histology variables. OUTCOMES: Time to end-stage renal disease (ESRD)...
March 16, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Thomas Muelleman, Sreeya Yalamanchali, Yelizaveta Shnayder
Parathyroid glands undergo a variable descent during embryologic development and can be found anywhere in the neck from the level of the mandible to the mediastinum. To the best of our knowledge, we present the first report of a patient who was found to have bilateral parathyroid adenomas in her pyriform sinuses. A middle-aged woman with renal failure and secondary hyperparathyroidism presented with dysphagia and was found to have bilateral pyriform sinus masses on endoscopy. We performed direct laryngoscopy and surgical excision of these masses, and they were found to be parathyroid adenomas...
March 2018: Ear, Nose, & Throat Journal
Shereen M Hamza, John E Hall
Renal sympathetic nerves contribute significantly to both physiological and pathophysiological phenomena. Evaluating renal sympathetic nerve activity (RSNA) is of great interest in many areas of research such as chronic kidney disease, hypertension, heart failure, diabetes and obesity. Unequivocal assessment of the role of the sympathetic nervous system is thus imperative for proper interpretation of experimental results and understanding of disease processes. RSNA has been traditionally measured in anesthetized rodents, including mice...
February 14, 2018: Journal of Visualized Experiments: JoVE
Mohammed N Alkhatib, Tamer Abd-Alghafoor, AlaaEldeen Elmassry, Loai Albarqouni, Bettina Böttcher, Maha Alfaqawi
BACKGROUND: Stroke is a leading cause of morbidity and mortality worldwide. The aim of this study was to assess the standard of care for patients with acute ischaemic stroke at the internal medicine department of Nasser Hospital, Gaza Strip. METHODS: For this retrospective clinical audit, we selected a random sample of 100 medical records for patients with stroke who were admitted to Nasser Hospital between January and August, 2016. Clinical practice was compared with the recommendations in the 2013 American Heart Association and American Stroke Association guidelines...
February 21, 2018: Lancet
Hongbo Chang, Jianning Zhang, Weidong Cao, Yaming Wang, Hulin Zhao, Rui Liu, Shengli Guo
The present study evaluated drug distribution and clinical safety in treating patients with cystic craniopharyngioma (CP) with intracavitary radiotherapy using phosphorus-32 (32 P) colloid. In total, 40 patients who were recently diagnosed with primary or recurrent cystic CP were enrolled into the study. Patients underwent stereotactic intracavitary therapy and were administered32 P colloid and iopamidol-300 (1:1 dilution). Head computed tomography (CT) scans were performed 2 h after surgery in order to assess drug distribution and leakage...
April 2018: Oncology Letters
Daniel D Bohl, Nathaniel T Ondeck, Brian Darrith, Charles P Hannon, Yale A Fillingham, Craig J Della Valle
BACKGROUND: Little is known regarding the impact of operative time on adverse events following arthroplasty. The present study tests for associations between a 15-minute increase in operative time and the occurrence of adverse events following primary total joint arthroplasty. METHODS: Patients undergoing primary total hip or knee arthroplasty during 2006-2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program. Operative time (as a continuous variable) was tested for association with perioperative outcomes using multivariate regression...
February 17, 2018: Journal of Arthroplasty
Domenico Umberto De Rose, Silvia Giliani, Lucia Dora Notarangelo, Vassilios Lougaris, Arnalda Lanfranchi, Daniele Moratto, Baldassarre Martire, Fernando Specchia, Alberto Tommasini, Alessandro Plebani, Raffaele Badolato
Leukocyte Adhesion Deficiency type 1 (LAD-1) is a rare primary immunodeficiency due to mutations in the gene encoding for the common β-chain of the β2 integrin family (CD18). Herein, we describe clinical manifestations and long-term complications of eight LAD-1 patients. Four LAD-1 patients were treated with hematopoietic stem cell transplantation (HSCT), while the remaining four, including two with moderate LAD-1 deficiency, received continuous antibiotic prophylaxis. Untreated patients presented numerous infections and autoimmune manifestations...
March 13, 2018: Clinical Immunology: the Official Journal of the Clinical Immunology Society
Maroua Eid, Olivier Fouquet, Cédric Darreau, Marc Pierrot, Achille Kouatchet, Alain Mercat, Christophe Baufreton
INTRODUCTION: Necrotizing fasciitis represents a life-threatening infectious condition that causes spreading necrotisis of superficial fascia and subcutaneous cellular tissues. We describe the case of a patient diagnosed with septic and toxic shocks leading to multiple organ failure successfully treated with a combination of extracorporeal life support, continuous renal replacement therapy, and a hemoadsorption device. METHODS: A 41-year-old patient presented with necrotizing fasciitis and multi-organ failure...
March 2018: International Journal of Artificial Organs
Salvatore Grisanti, Deborah Cosentini, Valeria Tovazzi, Susanna Bianchi, Barbara Lazzari, Francesca Consoli, Elisa Roca, Alfredo Berruti, Vittorio D Ferrari
PURPOSE: Trabectedin is one of the few active agents in soft tissue sarcoma (STS) but hepatotoxicity is frequent and represents a dose-limiting factor. Protective strategies aiming at counteracting this important side effect have a crucial clinical impact. Due to its antioxidant properties, N-acetylcysteine (NAC) has a recognized hepatoprotective effect and this provides the rationale for testing NAC in the management of trabectedin-induced hepatotoxicity. METHODS: Patients with recurrent or metastatic soft tissue sarcoma, consecutively observed at our institution, who were considered eligible to trabectedin, received concomitant NAC if they had impaired hepatic or renal function at baseline or developed hepatotoxicity during treatment...
March 15, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
D Czock, V Schwenger, D Kindgen-Milles, M Joannidis, S John, M Schmitz, A Jörres, A Zarbock, M Oppert, J T Kielstein, C Willam
BACKGROUND: Many anti-infective drugs require dose adjustments in critically ill patients with acute kidney injury (AKI) and renal replacement therapy, in order to achieve adequate therapeutic drug concentrations. OBJECTIVES: The fundamental pharmacokinetic and pharmacodynamic principles of drug dose adjustment are presented. Recommendations on anti-infective drug dosage in intensive care are provided. MATERIALS AND METHODS: We established dose recommendations of selected anti-infective drugs based on information in the summary of product characteristics, published studies and recommendations, pharmacokinetic and pharmacodynamic considerations, and the experience and expert opinion of the authors...
March 15, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
V Schwenger, D Kindgen-Milles, C Willam, A Jörres, W Druml, D Czock, S J Klein, M Oppert, M Schmitz, J T Kielstein, A Zarbock, M Joannidis, S John
BACKGROUND: Acute kidney injury (AKI) is a common complication in intensive care unit (ICU) patients. The incidence of AKI in ICU patients exceeds 50% and the associated morbidity and mortality rates increase with severity of AKI. In addition, long-term consequences of AKI are underestimated and several studies show impaired long-term outcome after AKI. In about 5-25% of ICU patients with AKI renal replacement therapy (RRT) is required. OBJECTIVES: To assist in indication, timing, modality and application of renal replacement therapy of adult patients, current recommendations from the renal sections of the DGIIN (Deutschen Gesellschaft für Internistische Intensivmedizin und Notfallmedizin), ÖGIAIN (Österreichischen Gesellschaft für Internistische und Allgemeine Intensivmedizin und Notfallmedizin) and DIVI (Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin) are stated...
March 15, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
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