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AKI Treatment

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83 papers 25 to 100 followers
By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
https://www.readbyqxmd.com/read/28614822/drug-discovery-to-halt-the-progression-of-acute-kidney-injury-to-chronic-kidney-disease-a-case-for-phenotypic-drug-discovery-in-acute-kidney-injury
#1
Neil Hukriede, Andreas Vogt, Mark de Caestecker
The cellular responses that occur following acute kidney injury (AKI) are complex and dynamic, involving multiple cells types and molecular pathways. For this reason, early selection of defined molecular targets for therapeutic intervention is unlikely to be effective in complex in vivo models of AKI, let alone Phase 3 clinical trials in patients with even more complex AKI pathobiology. Phenotypic screening using zebrafish provides an attractive alternative that does not require prior knowledge of molecular targets and may identify compounds that modify multiple targets that might be missed in more traditional target-based screens...
June 15, 2017: Nephron
https://www.readbyqxmd.com/read/28601936/acute-kidney-injury-emerging-pharmacotherapies-in-current-clinical-trials
#2
Stefanie Woolridge Benoit, Prasad Devarajan
Acute kidney injury (AKI) is a significant source of morbidity and mortality in pediatric patients, affecting more than one quarter of critically ill children. Despite significant need, there are no targeted therapies to reliably prevent or treat AKI. Recent advances in our understanding of renal injury and repair signaling pathways have enabled the development of several targeted pharmaceuticals. Here we review emerging pharmacotherapies for AKI that are currently in clinical trials. Categorized by their general mechanism of action, the therapies discussed include anti-inflammatory agents (recAP, AB103, ABT-719), antioxidants (iron chelators, heme arginate), vasodilators (levosimendan), apoptosis inhibitors (QPI-1002), and repair agents (THR-184, BB-3, mesenchymal stem cells)...
June 10, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28595190/nonpharmacological-biomechanical-approaches-to-control-inflammation-in-acute-kidney-injury
#3
Shinji Tanaka, Tsuyoshi Inoue, John A Hossack, Mark D Okusa
Inflammation is broadly recognized as an important factor in the pathogenesis of acute kidney injury (AKI), but pharmacological approaches to alleviate inflammation in AKI have been without success in clinical trials. Neuromodulation by nonpharmacological methods is emerging as a novel therapeutic strategy to treat inflammatory diseases. Recently, our group and others have demonstrated that vagus nerve stimulation and pulsed ultrasound ameliorated inflammation via the cholinergic anti-inflammatory pathway (CAP) in various animal models, including renal ischemia-reperfusion injury...
June 9, 2017: Nephron
https://www.readbyqxmd.com/read/28586767/quantification-and-dosing-of-renal-replacement-therapy-in-acute-kidney-injury-a-reappraisal
#4
William R Clark, Martine Leblanc, Zaccaria Ricci, Claudio Ronco
BACKGROUND/AIMS: Delivered dialysis therapy is routinely measured in the management of patients with end-stage renal disease; yet, the quantification of renal replacement prescription and delivery in acute kidney injury (AKI) is less established. While continuous renal replacement therapy (CRRT) is widely understood to have greater solute clearance capabilities relative to intermittent therapies, neither urea nor any other solute is specifically employed for CRRT dose assessments in clinical practice at present...
2017: Blood Purification
https://www.readbyqxmd.com/read/28577734/-renal-replacement-therapy-for-acute-kidney-injury-in-the-intensive-care-unit
#5
Stéphane Gaudry, Khalil Chaïbi, Nicolas Bénichou, Charles Verney, David Hajage, Didier Dreyfuss
Renal replacement therapy for acute kidney injury has been used for more than 60 years. Except when life-threatening metabolic complications such as severe hyperkalaemia are present, renal replacement therapy initiation criteria are the subject of intense debate. Significant progress has been made with the publication of the AKIKI multicenter trial, which showed that a delayed renal replacement therapy initiation strategy (in the absence of life-threatening metabolic complications) was not associated with a difference in mortality compared to an early renal replacement therapy initiation strategy...
April 2017: Néphrologie & Thérapeutique
https://www.readbyqxmd.com/read/28577746/-non-dialytic-treatment-of-acute-kidney-injury
#6
Julien Demiselle, Nicolas Lerolle
Acute kidney injury is frequently encountered in patients in intensive care units and is associated with higher risk of mortality and chronic renal failure. Even small increases in serum creatinine are associated with adverse outcomes. Many interventions have been proposed to prevent or treat acute kidney injury in patients in intensive care units. However, no intervention has proved its efficacy in large randomized control trials. This review presents the various attempts aiming at acute kidney injury improvement in patients in intensive care units published over the recent years: hemodynamic interventions, "usual" drugs used in intensive care units, modulation of inflammation and hemostasis, remote ischemic conditioning, drugs specifically dedicated for acute kidney injury, and stimulation of renal recovery...
April 2017: Néphrologie & Thérapeutique
https://www.readbyqxmd.com/read/28521019/a-whole-system-approach-to-improving-mortality-associated-with-acute-kidney-injury
#7
Thangavelu Chandrasekar, Asheesh Sharma, Lucinda Tennent, Christopher Wong, Peter Chamberlain, Kottarathil A Abraham
BACKGROUND: Acute kidney injury (AKI) is in the main managed by non-nephrologists, many who feel challenged by or lack awareness of the complexity that the renal element adds to their patients' care. National reports have raised major concerns about the quality of care and have predicted that mortality reductions of 30% are achievable with good medical practice. AIM: This quality improvement project evaluated whether a whole system approach could improve outcomes for patients with AKI...
May 18, 2017: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/28470347/fluid-management-in-acute-kidney-injury
#8
REVIEW
Anders Perner, John Prowle, Michael Joannidis, Paul Young, Peter B Hjortrup, Ville Pettilä
Acute kidney injury (AKI) and fluids are closely linked through oliguria, which is a marker of the former and a trigger for administration of the latter. Recent progress in this field has challenged the physiological and clinical rational of using oliguria as a trigger for the administration of fluid and brought attention to the delicate balance between benefits and harms of different aspects of fluid management in critically ill patients, in particular those with AKI. This narrative review addresses various aspects of fluid management in AKI outlining physiological aspects, the effects of crystalloids and colloids on kidney function and the effect of various resuscitation and de-resuscitation strategies on the course and outcome of AKI...
May 3, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28466293/-renal-replacement-therapy-in-acute-kidney-injury
#9
REVIEW
S J Klein, M Joannidis
Acute kidney injury is still a common complication in intensive care units and is associated with a significantly increased risk for morbidity and mortality. Various treatment concepts, like continuous renal replacement therapy (RRT) or (modified) intermittent procedures, as well as different methods of anticoagulation and the general decision of when and if to initiate RRT have to be considered by the treating physician. While giving vital input on when to initiate RRT, the German ELAIN (Early versus late initiation of renal replacement therapy in critically ill patients) trial and the French AKIKI (The artificial kidney initiation in kidney injury) trial raised many more questions...
June 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28455887/human-adipose-stromal-cell-therapy-improves-survival-and-reduces-renal-inflammation-and-capillary-rarefaction-in-acute-kidney-injury
#10
Jason A Collett, Dmitry O Traktuev, Purvi Mehrotra, Allison Crone, Stephanie Merfeld-Clauss, Keith L March, David P Basile
Damage to endothelial cells contributes to acute kidney injury (AKI) by causing impaired perfusion, while the permanent loss of the capillary network following AKI has been suggested to promote chronic kidney disease. Therefore, strategies to protect renal vasculature may impact both short-term recovery and long-term functional preservation post-AKI. Human adipose stromal cells (hASCs) possess pro-angiogenic and anti-inflammatory properties and therefore have been tested as a therapeutic agent to treat ischaemic conditions...
April 28, 2017: Journal of Cellular and Molecular Medicine
https://www.readbyqxmd.com/read/28388752/-acute-kidney-injury-potentials-to%C3%A2-improve-aki-related-health-care-structure
#11
REVIEW
Christian Nusshag, Konrad Obermann, Markus Weigand, Vedat Schwenger
Since 2005 the AKI numbers nearly increased threefold. The prevailing health care structure for AKI-management in Germany possesses major potential for improvement. Despite a clear advantage regarding mortality and renal recovery, the cost-intensive CRRT is the predominant procedure in AKI-therapy. Conversion of 85 % of the CRRT-procedures to a dialysis procedure (IHD/SLED) enables annual savings in AKI-therapy by 7.3 million Euros. A reinvestment can finance a strengthened collaboration with licensed nephrologists to improve therapy quality and availability of RRT-units in local hospitals...
April 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28348102/acute-peritoneal-dialysis-in-patients-with-acute-kidney-injury
#12
Seong Cho, Sung-Rok Kim, Yu-Ji Lee
♦ Background: The purpose of this study was to evaluate the efficacy, complications, and mortality rate associated with acute peritoneal dialysis (PD) in patients with acute kidney injury (AKI). ♦ Methods: A total of 75 patients who were treated at Samsung Changwon Hospital between February 2005 and March 2016 were included in the study sample. The outcomes included in-hospital survival, renal recovery, metabolic and fluid control rates, and technical success rates. ♦ Results: Refractory heart failure was the most frequent cause of acute PD (49...
March 27, 2017: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
https://www.readbyqxmd.com/read/28321822/the-exciting-bench-to-bedside-journey-of-cell-therapies-for-acute-kidney-injury-and-renal-transplantation
#13
REVIEW
Sergio Dellepiane, Davide Medica, Alessandro Domenico Quercia, Vincenzo Cantaluppi
Acute kidney injury (AKI) is characterized by an increasing incidence and poor outcomes in both developed and undeveloped countries. AKI is also acquiring importance in the setting of kidney transplantation (KT): besides all the classical forms of AKI that KT patients may undergo, several transplant-specific injuries can also lead to the loss of graft function. The mechanisms of tissue damage in native and grafted kidneys share several common pathogenic elements. Since appropriate therapeutic treatments are still lacking-probably due to the disease complexity-clinicians are forced to provide only supportive care...
March 21, 2017: Journal of Nephrology
https://www.readbyqxmd.com/read/28222898/strategies-for-the-optimal-timing-to-start-renal-replacement-therapy-in-critically-ill-patients-with-acute-kidney-injury
#14
REVIEW
Sean M Bagshaw, Ron Wald
Renal replacement therapy (RRT) is increasingly utilized to support critically ill patients with severe acute kidney injury (AKI). The question of whether and when to start RRT for a critically ill patient with AKI has long troubled clinicians. When severe complications of AKI develop, the need to commence RRT is unambiguous. In the absence of such complications but in the presence of severe AKI, the optimal time and thresholds for starting RRT are uncertain. The majority of existing data have largely been derived from observational studies...
May 2017: Kidney International
https://www.readbyqxmd.com/read/28166726/endothelial-colony-forming-cells-ecfcs-in-murine-aki-implications-for-future-cell-based-therapies
#15
D Patschan, K Schwarze, B Tampe, M Zeisberg, S Patschan, G A Müller
BACKGROUND: In recent years, early Endothelial Progenitor Cells (eEPCs) have been proven as effective tool in murine ischemic AKI and in diabetic nephropathy. The mechanisms of eEPC-mediated vasoprotection have been elucidated in detail. Besides producing a diverse range of humoral factors, the cells also act by secreting vasomodulatory microvesicles. Only few data in contrast have been published about the role of so-called Endothelial Colony Forming Cells (ECFCs - late EPCs) in ischemic AKI...
February 6, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28139396/heme-oxygenase-1-as-a-therapeutic-target-in-acute-kidney-injury
#16
Subhashini Bolisetty, Abolfazl Zarjou, Anupam Agarwal
A common clinical condition, acute kidney injury (AKI) significantly influences morbidity and mortality, particularly in critically ill patients. The pathophysiology of AKI is complex and involves multiple pathways, including inflammation, autophagy, cell-cycle progression, and oxidative stress. Recent evidence suggests that a single insult to the kidney significantly enhances the propensity to develop chronic kidney disease. Therefore, the generation of effective therapies against AKI is timely. In this context, the cytoprotective effects of heme oxygenase 1 (HO-1) in animal models of AKI are well documented...
April 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28137829/inhibition-of-reticulon-1a-mediated-endoplasmic-reticulum-stress-in-early-aki-attenuates-renal-fibrosis-development
#17
Ying Fan, Wenzhen Xiao, Kyung Lee, Fadi Salem, Jiejun Wen, Li He, Jing Zhang, Yang Fei, Dongsheng Cheng, Hongda Bao, Yumei Liu, Fujun Lin, Gengru Jiang, Zhiyong Guo, Niansong Wang, John Cijiang He
Several animal studies have shown an important role for endoplasmic reticulum (ER) stress in AKI, whereas human studies are lacking. We recently reported that Reticulon-1A (RTN1A) is a key mediator of ER stress and kidney cell injury. Here, we investigated whether modulation of RTN1A expression during AKI contributes to the progression to CKD. In a retrospective study of 51 patients with AKI, increased expression of RTN1A and other ER stress markers were associated with the severity of kidney injury and with progression to CKD...
January 30, 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/28129785/human-umbilical-cord-derived-mesenchymal-stromal-cells-protect-against-premature-renal-senescence-resulting-from-oxidative-stress-in-rats-with-acute-kidney-injury
#18
Camila Eleuterio Rodrigues, José Manuel Condor Capcha, Ana Carolina de Bragança, Talita Rojas Sanches, Priscila Queiroz Gouveia, Patrícia Aparecida Ferreira de Oliveira, Denise Maria Avancini Costa Malheiros, Rildo Aparecido Volpini, Mirela Aparecida Rodrigues Santinho, Bárbara Amélia Aparecida Santana, Rodrigo do Tocantins Calado, Irene de Lourdes Noronha, Lúcia Andrade
BACKGROUND: Mesenchymal stromal cells (MSCs) represent an option for the treatment of acute kidney injury (AKI). It is known that young stem cells are better than are aged stem cells at reducing the incidence of the senescent phenotype in the kidneys. The objective of this study was to determine whether AKI leads to premature, stress-induced senescence, as well as whether human umbilical cord-derived MSCs (huMSCs) can prevent ischaemia/reperfusion injury (IRI)-induced renal senescence in rats...
January 28, 2017: Stem Cell Research & Therapy
https://www.readbyqxmd.com/read/28128881/effect-of-sustained-low-efficient-dialysis-versus-continuous-renal-replacement-therapy-on-renal-recovery-after-acute-kidney-injury-in-the-intensive-care-unit-a-systematic-review-and-meta-analysis
#19
REVIEW
Bernadett Kovacs, Katrina J Sullivan, Swapnil Hiremath, Rakesh V Patel
Critically ill adults with acute kidney injury (AKI) experience considerable morbidity and mortality. Controversy remains regarding the optimal renal replacement intervention for these patients. Our systematic review aimed to determine the effect(s) of sustained low-efficiency dialysis (SLED) compared with continuous renal replacement (CRRT) therapy on relevant patient outcomes. A systematic search of Medline, Embase, CINAHL and the Cochrane Library was conducted. Identified citations were screened independently in duplicate for relevance, and the methodological quality of included studies was evaluated...
May 2017: Nephrology
https://www.readbyqxmd.com/read/28119408/a-decision-making-algorithm-for-initiation-and-discontinuation-of-rrt-in-severe-aki
#20
Mallika L Mendu, George R Ciociolo, Sarah R McLaughlin, Dionne A Graham, Roya Ghazinouri, Siddharth Parmar, Alissa Grossier, Rebecca Rosen, Karl R Laskowski, Leonardo V Riella, Emily S Robinson, David M Charytan, Joseph V Bonventre, Jeffrey O Greenberg, Sushrut S Waikar
BACKGROUND AND OBJECTIVES: AKI is an increasingly common and devastating complication in hospitalized patients. Severe AKI requiring RRT is associated with in-hospital mortality rates exceeding 40%. Clinical decision making related to RRT initiation for patients with AKI in the medical intensive care unit is not standardized. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a 13-month (November of 2013 to December of 2014) prospective cohort study in an academic medical intensive care unit involving the implementation of an AKI Standardized Clinical Assessment and Management Plan, a decision-making algorithm to assist front-line clinicians caring for patients with AKI...
February 7, 2017: Clinical Journal of the American Society of Nephrology: CJASN
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