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AKI Treatment

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107 papers 25 to 100 followers
By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
https://www.readbyqxmd.com/read/29355173/paradigms-of-acute-kidney-injury-in-the-intensive-care-setting
#1
REVIEW
John A Kellum, John R Prowle
Acute kidney injury (AKI) is a heterogeneous clinical syndrome that has multiple aetiologies, variable pathogenesis and diverse outcomes. However, these heterogeneities are not reflected in current approaches to the diagnosis and, to some degree, treatment of AKI. For example, congestive heart failure and dehydration can produce identical changes in serum creatinine level and urine output (parameters that are used to define AKI); however, they differ vastly in their physiological contexts and demand completely opposite treatments...
January 22, 2018: Nature Reviews. Nephrology
https://www.readbyqxmd.com/read/29324487/renal-replacement-therapy-in-critically-ill-patients-who-when-why-and-how
#2
Melanie Meersch, Alexander Zarbock
PURPOSE OF REVIEW: The increasing incidence of acute kidney injury has the immediate effect of a growing need for renal replacement therapy (RRT). Shedding light on the questions of who, when, why, and how RRT should be performed is difficult to accomplish because of ambiguous study results, poor quality evidence, and low standardization. RECENT FINDINGS: Critically ill patients are exposed to multiple factors known to deteriorate kidney function. Especially severe fluid overload is strongly associated with worse outcome and may be considered as a trigger for initiating RRT...
January 10, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29270416/stem-cell-extracellular-vesicles-and-kidney-injury
#3
REVIEW
Cristina Grange, Corinne Iampietro, Benedetta Bussolati
Extracellular vesicles (EVs) appear as a new promising cell-free therapy for acute and chronic renal diseases. EVs retain characteristics of the cell of origin and those derived from stem cells may mimic their regenerative properties per se. In fact, EVs contain many active molecules such as proteins and RNA species that act on target cells through different mechanisms, stimulating proliferation and angiogenesis and reducing apoptosis and inflammation. There are several reports that demonstrate a general regenerative potential of EVs derived from mesenchymal stromal cells (MSCs) of different sources in kidney injury models...
2017: Stem Cell Investigation
https://www.readbyqxmd.com/read/29270486/novel-therapies-for-acute-kidney-injury
#4
REVIEW
Huaizhen Chen, Laurence William Busse
Acute kidney injury (AKI) is a common disease with a complex pathophysiology. The old paradigm of identifying renal injury based on location-prerenal, intrarenal, and postrenal-is now being supplanted with a new paradigm based on observable kidney injury patterns. The pathophysiology of AKI on a molecular and microanatomical level includes inflammation, immune dysregulation, oxidative injury, and impaired microcirculation. Treatment has traditionally been supportive, including the avoidance of nephrotoxins, judicious volume and blood pressure management, hemodynamic monitoring, and renal replacement therapy...
September 2017: KI Reports
https://www.readbyqxmd.com/read/29245956/combination-therapy-of-exendin-4-and-allogenic-adipose-derived-mesenchymal-stem-cell-preserved-renal-function-in-a-chronic-kidney-disease-and-sepsis-syndrome-setting-in-rats
#5
Chih-Hung Chen, Ben-Chung Cheng, Kuan-Hung Chen, Pei-Lin Shao, Pei-Hsun Sung, Hsin-Ju Chiang, Chih-Chao Yang, Kun-Chen Lin, Cheuk-Kwan Sun, Jiunn-Jye Sheu, Hsueh-Wen Chang, Mel S Lee, Hon-Kan Yip
Combined therapy with exendin-4 (Ex4) and allogenic adipose-derived mesenchymal stem cells (ADMSC) was tested against either therapy alone for protecting kidney function against chronic kidney disease (CKD) complicated by sepsis syndrome (SS) [i.e., by intraperitoneal injection of cecal-derived bacteria (1.0 × 104) cells/milliliter/total 5.0 cc].Adult-male-Sprague Dawley rats (n=36) were equally divided into group 1 (sham-control), group 2 (CKD), group 3 (CKD-SS), group 4 (CKD-SS-Ex4), group 5 (CKD-SS-ADMSC) and group 6 (CKD-SS-Ex4-ADMSC)...
November 21, 2017: Oncotarget
https://www.readbyqxmd.com/read/29248144/renal-replacement-therapy-for-aki-when-how-much-when-to-stop
#6
REVIEW
Stefano Romagnoli, William R Clark, Zaccaria Ricci, Claudio Ronco
Severe acute kidney injury (AKI) requiring renal replacement therapy (RRT) is a serious clinical disorder in the intensive care unit (ICU), occurring in a significant proportion of critically ill patients. However, many questions remain about the optimal administration of RRT with regard to several important considerations, including treatment dose, timing of treatment initiation and cessation, therapy mode, type of anticoagulation, and management of fluid overload. While Level 1 evidence exists for RRT dosing in AKI, all the studies contributing to this evidence base employed fixed-dose regimens throughout a patient's continuous RRT (CRRT) course, without regard for the possibility of individualizing treatment dose according to the clinical status of a given patient at a specific time...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29257336/autophagy-a-new-treatment-strategy-for-msc-based-therapy-in-acute-kidney-injury-review
#7
Haoyuan Jia, Yongmin Yan, Zhaofeng Liang, Nitin Tandra, Bin Zhang, Juanjuan Wang, Wenrong Xu, Hui Qian
Acute kidney injury (AKI) is a common and serious medical condition associated with poor health outcomes. Autophagy is a conserved multistep pathway that serves a major role in many biological processes and diseases. Recent studies have demonstrated that autophagy is induced in proximal tubular cells during AKI. Autophagy serves a pro‑survival or pro‑death role under certain conditions. Furthermore, mesenchymal stem cells (MSCs) have therapeutic potential in the repair of renal injury. This review summarizes the recent progress on the role of autophagy in AKI and MSCs‑based therapy for AKI...
December 19, 2017: Molecular Medicine Reports
https://www.readbyqxmd.com/read/29247527/high-volume-forced-diuresis-with-matched-hydration-using-the-renalguard-system-to-prevent-contrast-induced-nephropathy-a-meta-analysis-of-randomized-trials
#8
Rahman Shah, Sarah J Wood, Sajjad A Khan, Amina Chaudhry, M Rehan Khan, Mohamed S Morsy
BACKGROUND: Contrast-induced nephropathy (CIN) is a well-recognized complication of coronary angiography that is associated with poor outcomes. Several small randomized controlled trials (RCTs) have recently shown that in patients with chronic kidney disease (CKD), furosemide-induced forced diuresis with matched hydration using the RenalGuard system can prevent its occurrence. However, individual studies have been underpowered and thus cannot show significant differences in major clinical endpoints...
December 16, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/29196304/long-term-clinical-outcomes-after-early-initiation-of-rrt-in-critically-ill-patients-with-aki
#9
Melanie Meersch, Mira Küllmar, Christoph Schmidt, Joachim Gerss, Toni Weinhage, Andreas Margraf, Thomas Ermert, John A Kellum, Alexander Zarbock
Whether earlier initiation of RRT in critically ill patients with AKI can improve outcomes remains debated. We examined follow-up data from a large clinical trial to prospectively investigate the long-term outcomes associated with the timing of RRT initiation in such patients. We extended the follow-up of patients in the Early Versus Delayed Initiation of RRT in Critically Ill Patients with AKI (ELAIN) Trial from 90 days to 1 year after randomization for 230 (99.6%) patients. The primary outcome was a composite of major adverse kidney events (persistent renal dysfunction, dialysis dependence, and mortality) at 1 year...
December 1, 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/29186517/renal-replacement-therapy-intensity-for-acute-kidney-injury-and-recovery-to-dialysis-independence-a-systematic-review-and-individual-patient-data-meta-analysis
#10
Ying Wang, Martin Gallagher, Qiang Li, Serigne Lo, Alan Cass, Simon Finfer, John Myburgh, Catherine Bouman, Robert Faulhaber-Walter, John A Kellum, Paul M Palevsky, Claudio Ronco, Patrick Saudan, Ashita Tolwani, Rinaldo Bellomo
Background: There is no consensus whether higher intensity dose renal replacement therapy (RRT) compared with standard intensity RRT has survival benefit and achieves better renal recovery in acute kidney injury (AKI). Methods: In an individual patient data meta-analysis, we merged individual patient data from randomized controlled trials (RCTs) comparing high with standard intensity RRT in intensive care unit patients with severe AKI. The primary outcome was all-cause mortality...
November 23, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/29188454/a-narrative-review-of-the-impact-of-interventions-in-acute-kidney-injury
#11
REVIEW
Lynne Sykes, Rob Nipah, Philip Kalra, Darren Green
Acute kidney injury (AKI) is independently associated with significant morbidity and mortality, and is thus an important challenge facing physicians in modern healthcare. This narrative review assesses the impact of strategies employed to tackle AKI following the 2009 NCEPOD report on acute kidney injury (Sterwart et al. Acute kidney injury: adding insult to injury, pp 1-22, 2009). There is scarce and heterogeneous research into hard end points such as mortality and AKI progression for AKI interventions. This review found that e-alerts have varying effects on mortality and AKI progression, but decrease the incidence of contrast-induced AKI...
November 29, 2017: Journal of Nephrology
https://www.readbyqxmd.com/read/29155815/allopurinol-attenuates-acute-kidney-injury-following-bothrops-jararaca-envenomation
#12
Pedro Henrique França Gois, Monique Silva Martines, Daniela Ferreira, Rildo Volpini, Daniele Canale, Ceila Malaque, Renato Crajoinas, Adriana Castello Costa Girardi, Maria Heloisa Massola Shimizu, Antonio Carlos Seguro
Snakebites have been recognized as a neglected public health problem in several tropical and subtropical countries. Bothrops snakebites frequently complicate with acute kidney injury (AKI) with relevant morbidity and mortality. To date, the only treatment available for Bothrops envenomation is the intravenous administration of antivenom despite its several limitations. Therefore, the study of novel therapies in Bothrops envenomation is compelling. The aim of this study was to evaluate the protective effect of Allopurinol (Allo) in an experimental model of Bothrops jararaca venom (BJ)-associated AKI...
November 2017: PLoS Neglected Tropical Diseases
https://www.readbyqxmd.com/read/29097621/clinical-decision-support-for-in-hospital-aki
#13
Mohammed Al-Jaghbeer, Dilhari Dealmeida, Andrew Bilderback, Richard Ambrosino, John A Kellum
AKI carries a significant mortality and morbidity risk. Use of a clinical decision support system (CDSS) might improve outcomes. We conducted a multicenter, sequential period analysis of 528,108 patients without ESRD before admission, from October of 2012 to September of 2015, to determine whether use of a CDSS reduces hospital length of stay and in-hospital mortality for patients with AKI. We compared patients treated 12 months before (181,696) and 24 months after (346,412) implementation of the CDSS. Coprimary outcomes were hospital mortality and length of stay adjusted by demographics and comorbidities...
February 2018: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/29088005/renal-replacement-therapy-modality-in-the-icu-and-renal-recovery-at-hospital-discharge
#14
Martin Bonnassieux, Antoine Duclos, Antoine G Schneider, Aurélie Schmidt, Stève Bénard, Charlotte Cancalon, Olivier Joannes-Boyau, Carole Ichai, Jean-Michel Constantin, Jean-Yves Lefrant, John A Kellum, Thomas Rimmelé
OBJECTIVES: Acute kidney injury requiring renal replacement therapy is a major concern in ICUs. Initial renal replacement therapy modality, continuous renal replacement therapy or intermittent hemodialysis, may impact renal recovery. The aim of this study was to assess the influence of initial renal replacement therapy modality on renal recovery at hospital discharge. DESIGN: Retrospective cohort study of all ICU stays from January 1, 2010, to December 31, 2013, with a "renal replacement therapy for acute kidney injury" code using the French hospital discharge database...
October 28, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29057120/ivc-measurements-in-critically-ill-patients-with-acute-renal-failure
#15
Rami Jambeih, Jean I Keddissi, Houssein A Youness
OBJECTIVE: To determine whether the inferior vena cava (IVC) measurement by bedside ultrasound (US-IVC) predicts improvement in renal function in patients with acute kidney injury (AKI). DESIGN: Prospective observational study. SETTING: Medical intensive care unit. PATIENTS: 33 patients with AKI were included. INTERVENTION: US-IVC was done on admission. The patients' management was done by the primary teams, who were unaware of the US-IVC findings...
2017: Critical Care Research and Practice
https://www.readbyqxmd.com/read/29039628/early-versus-late-initiation-of-renal-replacement-therapy-in-patients-with-acute-kidney-injury-a-meta-analysis-of-randomised-clinical-trials
#16
Thomas A Mavrakanas, D Ezra Aurian-Blajeni, David M Charytan
AIMS OF THE STUDY: The optimal timing of renal replacement therapy (RRT) initiation in acute kidney injury (AKI) remains a matter of debate. A systematic review and meta-analysis of randomised controlled trials (RCTs) was conducted to better estimate the effects of early initiation of RRT compared with late initiation of RRT among patients with AKI and in patients at risk for AKI. METHODS: A Medline literature research was conducted in PubMed for RCTs in adult patients with AKI that compared different RRT initiation strategies (early vs late)...
October 17, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/28978157/the-optimal-time-of-initiation-of-renal-replacement-therapy-in-acute-kidney-injury-a-meta-analysis
#17
Kaiping Luo, Shufang Fu, Weidong Fang, Gaosi Xu
BACKGROUND: The impact on the timing of renal replacement therapy (RRT) initiation on clinical outcomes for patients with acute kidney injury (AKI) remains controversial. MATERIALS AND METHODS: We searched the Cochrane Library, EMBASE, Global Health, MEDLINE, PubMed, the International Clinical Trials Registry Platform, and Web of Science. RESULTS: We included 49 studies involving 9698 patients. Pooled analysis of 5408 critically ill patients with AKI showed that early RRT was significantly associated with reduced mortality compared to late RRT [odds ratio (OR), 0...
September 15, 2017: Oncotarget
https://www.readbyqxmd.com/read/28756872/retinoic-acid-improves-nephrotoxic-serum-induced-glomerulonephritis-through-activation-of-podocyte-retinoic-acid-receptor-%C3%AE
#18
Yan Dai, Anqun Chen, Ruijie Liu, Leyi Gu, Shuchita Sharma, Weijing Cai, Fadi Salem, David J Salant, Jeffrey W Pippin, Stuart J Shankland, Marcus J Moeller, Norbert B Ghyselinck, Xiaoqiang Ding, Peter Y Chuang, Kyung Lee, John Cijiang He
Proliferation of glomerular epithelial cells, including podocytes, is a key histologic feature of crescentic glomerulonephritis. We previously found that retinoic acid (RA) inhibits proliferation and induces differentiation of podocytes by activating RA receptor-α (RARα) in a murine model of HIV-associated nephropathy. Here, we examined whether RA would similarly protect podocytes against nephrotoxic serum-induced crescentic glomerulonephritis and whether this effect was mediated by podocyte RARα. RA treatment markedly improved renal function and reduced the number of crescentic lesions in nephritic wild-type mice, while this protection was largely lost in mice with podocyte-specific ablation of Rara (Pod-Rara knockout)...
December 2017: Kidney International
https://www.readbyqxmd.com/read/28807932/reducing-inflammatory-cytokine-production-from-renal-collecting-duct-cells-by-inhibiting-gata2-ameliorates-acute-kidney-injury
#19
Lei Yu, Takashi Moriguchi, Hiroshi Kaneko, Makiko Hayashi, Atsushi Hasegawa, Masahiro Nezu, Hideyuki Saya, Masayuki Yamamoto, Ritsuko Shimizu
Acute kidney injury (AKI) is a leading cause of chronic kidney disease. Proximal tubules are considered to be the primary origin of pathogenic inflammatory cytokines in AKI. However, it remains unclear whether other cell types, including collecting duct (CD) cells, participate in inflammatory processes. The transcription factor GATA2 is specifically expressed in CD cells and maintains their cellular identity. To explore the pathophysiological function of GATA2 in AKI, we generated renal tubular cell-specific Gata2 deletion (G2CKO) mice and examined their susceptibility to ischemia reperfusion injury (IRI)...
November 15, 2017: Molecular and Cellular Biology
https://www.readbyqxmd.com/read/28778860/pharmacologic-approaches-to-improve-mitochondrial-function-in-aki-and-ckd
#20
REVIEW
Hazel H Szeto
AKI is associated with high morbidity and mortality, and it predisposes to the development and progression of CKD. Novel strategies that minimize AKI and halt the progression of CKD are urgently needed. Normal kidney function involves numerous different cell types, such as tubular epithelial cells, endothelial cells, and podocytes, working in concert. This delicate balance involves many energy-intensive processes. Fatty acids are the preferred energy substrates for the kidney, and defects in fatty acid oxidation and mitochondrial dysfunction are universally involved in diverse causes of AKI and CKD...
October 2017: Journal of the American Society of Nephrology: JASN
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