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By Daniel Ries Private practice nephrology, clinical research, admin duties.
L Lee Hamm, Nazih Nakhoul, Kathleen S Hering-Smith
Acid-base homeostasis and pH regulation are critical for both normal physiology and cell metabolism and function. The importance of this regulation is evidenced by a variety of physiologic derangements that occur when plasma pH is either high or low. The kidneys have the predominant role in regulating the systemic bicarbonate concentration and hence, the metabolic component of acid-base balance. This function of the kidneys has two components: reabsorption of virtually all of the filtered HCO3(-) and production of new bicarbonate to replace that consumed by normal or pathologic acids...
December 7, 2015: Clinical Journal of the American Society of Nephrology: CJASN
Marit D Solbu, Alan G Jardine
No abstract text is available yet for this article.
February 2016: Nephrology, Dialysis, Transplantation
Alexander C Wiseman
Immunosuppressive agents are commonly used in the nephrologist's practice in the treatment of autoimmune and immune-mediated diseases and transplantation, and they are investigational in the treatment of AKI and ESRD. Drug development has been rapid over the past decades as mechanisms of the immune response have been better defined both by serendipity (the discovery of agents with immunosuppressive activity that led to greater understanding of the immune response) and through mechanistic study (the study of immune deficiencies and autoimmune diseases and the critical pathways or mutations that contribute to disease)...
February 5, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Sara N Davison, Adeera Levin, Alvin H Moss, Vivekanand Jha, Edwina A Brown, Frank Brennan, Fliss E M Murtagh, Saraladevi Naicker, Michael J Germain, Donal J O'Donoghue, Rachael L Morton, Gregorio T Obrador
Patients with advanced chronic kidney disease (CKD) have a high burden of physical and psychosocial symptoms, poor outcomes, and high costs of care. Current paradigms of care for this highly vulnerable population are variable, prognostic and assessment tools are limited, and quality of care, particularly regarding conservative and palliative care, is suboptimal. The KDIGO Controversies Conference on Supportive Care in CKD reviewed the current state of knowledge in order to define a roadmap to guide clinical and research activities focused on improving the outcomes of people living with advanced CKD, including those on dialysis...
September 2015: Kidney International
Michael W Kahn
Although the great physicians of past centuries might have called it something else, proficiency at promoting mindfulness has always been and should remain part of a doctor's clinical toolkit.
March 5, 2015: New England Journal of Medicine
Frank Bridoux, Nelson Leung, Colin A Hutchison, Guy Touchard, Sanjeev Sethi, Jean-Paul Fermand, Maria M Picken, Guillermo A Herrera, Efstathios Kastritis, Giampaolo Merlini, Murielle Roussel, Fernando C Fervenza, Angela Dispenzieri, Robert A Kyle, Samih H Nasr
Monoclonal gammopathy of renal significance (MGRS) regroups all renal disorders caused by a monoclonal immunoglobulin (MIg) secreted by a nonmalignant B-cell clone. By definition, patients with MGRS do not meet the criteria for overt multiple myeloma/B-cell proliferation, and the hematologic disorder is generally consistent with monoclonal gammopathy of undetermined significance (MGUS). However, MGRS is associated with high morbidity due to the severity of renal and sometimes systemic lesions induced by the MIg...
April 2015: Kidney International
Matthew R Weir, George L Bakris, David A Bushinsky, Martha R Mayo, Dahlia Garza, Yuri Stasiv, Janet Wittes, Heidi Christ-Schmidt, Lance Berman, Bertram Pitt
BACKGROUND: Hyperkalemia increases the risk of death and limits the use of inhibitors of the renin-angiotensin-aldosterone system (RAAS) in high-risk patients. We assessed the safety and efficacy of patiromer, a nonabsorbed potassium binder, in a multicenter, prospective trial. METHODS: Patients with chronic kidney disease who were receiving RAAS inhibitors and who had serum potassium levels of 5.1 to less than 6.5 mmol per liter received patiromer (at an initial dose of 4...
January 15, 2015: New England Journal of Medicine
Andrew D Rule, John C Lieske, Xujian Li, L Joseph Melton, Amy E Krambeck, Eric J Bergstralh
Most patients with first-time kidney stones undergo limited evaluations, and few receive preventive therapy. A prediction tool for the risk of a second kidney stone episode is needed to optimize treatment strategies. We identified adult first-time symptomatic stone formers residing in Olmsted County, Minnesota, from 1984 to 2003 and manually reviewed their linked comprehensive medical records through the Rochester Epidemiology Project. Clinical characteristics in the medical record before or up to 90 days after the first stone episode were evaluated as predictors for symptomatic recurrence...
December 2014: Journal of the American Society of Nephrology: JASN
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