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AKI Treatment

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77 papers 25 to 100 followers
By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
https://www.readbyqxmd.com/read/28521019/a-whole-system-approach-to-improving-mortality-associated-with-acute-kidney-injury
#1
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
#2
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
#3
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...
May 2, 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
#4
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
#5
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
#6
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
#7
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
#8
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...
February 17, 2017: Kidney International
https://www.readbyqxmd.com/read/28166726/endothelial-colony-forming-cells-ecfcs-in-murine-aki-implications-for-future-cell-based-therapies
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
https://www.readbyqxmd.com/read/28087726/benefit-of-mineralocorticoid-receptor-antagonism-in-aki-role-of-vascular-smooth-muscle-rac1
#15
Jonatan Barrera-Chimal, Gwennan André-Grégoire, Aurelie Nguyen Dinh Cat, Sebastian M Lechner, Jérôme Cau, Sonia Prince, Peter Kolkhof, Gervaise Loirand, Vincent Sauzeau, Thierry Hauet, Frédéric Jaisser
AKI is a frequent complication in hospitalized patients. Unfortunately, there is no effective pharmacologic approach for treating or preventing AKI. In rodents, mineralocorticoid receptor (MR) antagonism prevents AKI induced by ischemia-reperfusion (IR). We investigated the specific role of vascular MR in mediating AKI induced by IR. We also assessed the protective effect of MR antagonism in IR-induced AKI in the Large White pig, a model of human AKI. In mice, MR deficiency in smooth muscle cells (SMCs) protected against kidney IR injury...
April 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/28114128/intravenous-fluids-and-acute-kidney-injury
#16
REVIEW
Xiaoqiang Ding, Zhen Cheng, Qi Qian
Over 50% of the human body is comprised of fluids that are distributed in defined compartments. Although compartmentalized, these fluids are dynamically connected. Fluids, electrolytes, and acid-base balance in each compartment are tightly regulated, mostly in an energy-dependent manner to achieve their designed functions. For over a century, our understanding of the microvascular fluid homeostasis has evolved from hypothesized Ernest Starling principle to evidence-based and the revised Starling principle, incorporating the functional endothelial surface layer...
2017: Blood Purification
https://www.readbyqxmd.com/read/28028935/renoprotection-focus-on-trpv1-trpv4-trpc6-and-trpm2
#17
REVIEW
L Markó, M Mannaa, T N Haschler, S Krämer, M Gollasch
Members of the transient receptor potential (TRP) cation channel receptor family have unique sites of regulatory function in the kidney which enables them to promote regional vasodilatation and controlled Ca(2+) influx into podocytes and tubular cells. Activated TRP vanilloid 1 receptor channels (TRPV1) have been found to elicit renoprotection in rodent models of acute kidney injury following ischaemia/reperfusion. Transient receptor potential cation channel, subfamily C, member 6 (TRPC6) in podocytes is involved in chronic proteinuric kidney disease, particularly in focal segmental glomerulosclerosis (FSGS)...
March 2017: Acta Physiologica
https://www.readbyqxmd.com/read/28003911/automated-fluid-management-for-treatment-of-rhabdomyolysis
#18
Christian M Beilstein, John R Prowle, Christopher J Kirwan
Purpose. Fluid therapy aimed at increasing urine output is a commonly employed strategy to prevent acute kidney injury (AKI) in critically ill patients with rhabdomyolysis. Automated fluid management has the potential to optimise urine output while avoiding fluid accumulation in rhabdomyolysis patients. Methods. In a single centre clinical service evaluation we compared a convenience sample of critically ill adults with rhabdomyolysis treated with automated fluid management using the RenalGuard® device to patients managed with manual fluid adjustment following our standard rhabdomyolysis protocol...
2016: International Journal of Nephrology
https://www.readbyqxmd.com/read/27997816/recent-early-clinical-drug-development-for-acute-kidney-injury
#19
REVIEW
Kevin M Gallagher, Stephen O'neill, Ewen M Harrison, James A Ross, Stephen J Wigmore, Jeremy Hughes
Despite significant need and historical trials, there are no effective drugs in use for the prevention or treatment of acute kidney injury (AKI). There are several promising agents in early clinical development for AKI and two trials have recently been terminated. There are also exciting new findings in pre-clinical AKI research. There is a need to take stock of current progress in the field to guide future drug development for AKI. Areas covered: The main clinical trial registries, PubMed and pharmaceutical company website searches were used to extract the most recent clinical trials for sterile, transplant and sepsis-associated AKI...
February 2017: Expert Opinion on Investigational Drugs
https://www.readbyqxmd.com/read/27853353/update-on-sepsis-associated-acute-kidney-injury-emerging-targeted-therapies
#20
REVIEW
James F Doyle, Lui G Forni
Sepsis-associated acute kidney injury (SA-AKI) is an independent predictor of increased mortality and morbidity. It is essential that further advances in the treatment of sepsis should prioritize targeted therapies in SA-AKI in order to improve these bleak outcomes. As yet, a unique therapy that effectively reduces the impact of acute kidney injury has not been demonstrated. However, the emergence of novel targeted therapies, perhaps in combination, has the possibility of significantly reducing the long-term sequelae of an episode of SA-AKI...
2016: Biologics: Targets & Therapy
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