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Revista Da Associacao Medica Brasileira... Jan 2020Chronic kidney disease is highly prevalent (10-13% of the population), irreversible, progressive, and associated with higher cardiovascular risk. Patients with this... (Review)
Review
Chronic kidney disease is highly prevalent (10-13% of the population), irreversible, progressive, and associated with higher cardiovascular risk. Patients with this pathology remain asymptomatic most of the time, presenting the complications typical of renal dysfunction only in more advanced stages. Its treatment can be conservative (patients without indication for dialysis, usually those with glomerular filtration rate above 15 ml/minute) or replacement therapy (hemodialysis, peritoneal dialysis, and kidney transplantation). The objectives of the conservative treatment for chronic kidney disease are to slow down the progression of kidney dysfunction, treat complications (anemia, bone diseases, cardiovascular diseases), vaccination for hepatitis B, and preparation for kidney replacement therapy.
Topics: Humans; Kidney Failure, Chronic; Prevalence; Renal Dialysis; Renal Insufficiency; Renal Insufficiency, Chronic; Risk Factors
PubMed: 31939529
DOI: 10.1590/1806-9282.66.S1.3 -
The Lancet. Oncology Nov 2014This International Myeloma Working Group consensus updates the disease definition of multiple myeloma to include validated biomarkers in addition to existing... (Review)
Review
This International Myeloma Working Group consensus updates the disease definition of multiple myeloma to include validated biomarkers in addition to existing requirements of attributable CRAB features (hypercalcaemia, renal failure, anaemia, and bone lesions). These changes are based on the identification of biomarkers associated with near inevitable development of CRAB features in patients who would otherwise be regarded as having smouldering multiple myeloma. A delay in application of the label of multiple myeloma and postponement of therapy could be detrimental to these patients. In addition to this change, we clarify and update the underlying laboratory and radiographic variables that fulfil the criteria for the presence of myeloma-defining CRAB features, and the histological and monoclonal protein requirements for the disease diagnosis. Finally, we provide specific metrics that new biomarkers should meet for inclusion in the disease definition. The International Myeloma Working Group recommends the implementation of these criteria in routine practice and in future clinical trials, and recommends that future studies analyse any differences in outcome that might occur as a result of the new disease definition.
Topics: Biomarkers, Tumor; Bone Marrow Cells; Humans; Multiple Myeloma; Prognosis; Renal Insufficiency
PubMed: 25439696
DOI: 10.1016/S1470-2045(14)70442-5 -
The Veterinary Clinics of North... Apr 2022Chronic kidney disease (CKD) is rare in horses with an overall prevalence reported to be 0.12%. There is often a continuum from Acute Kidney Injury (AKI) to CKD, and... (Review)
Review
Chronic kidney disease (CKD) is rare in horses with an overall prevalence reported to be 0.12%. There is often a continuum from Acute Kidney Injury (AKI) to CKD, and patients with CKD may be predisposed to episodes of AKI. The most common clinical signs are non-specific with weight loss, polyuria/polydipsia and ventral edema. Less common clinical signs are poor appetite and performance, dull hair coat, oral ulcerations, gastro-intestinal ulceration, gingivitis, dental tartar and diarrhea. Rarely, horses may develop forebrain signs. Creatinine increases when at least 2/3 of kidney function have been lost and a more accurate assessment of kidney function is an estimated glomerular filtration rate measuring iohexol clearance time combined with protein content in the urine. Tubulointerstitial disease and glomerulonephritis are common causes of chronic kidney disease together with pyelonephritis and nephrolithiasis. Dietary changes and avoiding nephrotoxic drugs are key in slowing down the degenerative process.
Topics: Animals; Glomerular Filtration Rate; Horse Diseases; Horses; Kidney Failure, Chronic; Prognosis; Renal Insufficiency, Chronic
PubMed: 35365250
DOI: 10.1016/j.cveq.2021.11.003 -
Nephron 2022Kidney Disease Improving Global Outcomes (KDIGO) guidelines address the definition, classification, and management of acute kidney injury (AKI) and chronic kidney... (Review)
Review
Kidney Disease Improving Global Outcomes (KDIGO) guidelines address the definition, classification, and management of acute kidney injury (AKI) and chronic kidney disease (CKD). In practice, some clinical presentations of acute kidney diseases and disorders (AKD) do not meet the criteria for AKI or CKD. In principle, these presentations may be caused by the same diseases that cause AKI or CKD, which could be detected, evaluated, and treated before they evolve to AKI or CKD. In 2020, KDIGO convened a consensus conference to review recent evidence on the epidemiology of AKD and harmonize the definition and classification of AKD to be consistent with KDIGO definitions and classifications of AKI and CKD.
Topics: Acute Disease; Acute Kidney Injury; Consensus; Female; Humans; Kidney; Male; Renal Insufficiency, Chronic
PubMed: 34167119
DOI: 10.1159/000516647 -
Nature Reviews. Nephrology Apr 2017Consensus definitions have been reached for both acute kidney injury (AKI) and chronic kidney disease (CKD) and these definitions are now routinely used in research and...
Consensus definitions have been reached for both acute kidney injury (AKI) and chronic kidney disease (CKD) and these definitions are now routinely used in research and clinical practice. The KDIGO guideline defines AKI as an abrupt decrease in kidney function occurring over 7 days or less, whereas CKD is defined by the persistence of kidney disease for a period of >90 days. AKI and CKD are increasingly recognized as related entities and in some instances probably represent a continuum of the disease process. For patients in whom pathophysiologic processes are ongoing, the term acute kidney disease (AKD) has been proposed to define the course of disease after AKI; however, definitions of AKD and strategies for the management of patients with AKD are not currently available. In this consensus statement, the Acute Disease Quality Initiative (ADQI) proposes definitions, staging criteria for AKD, and strategies for the management of affected patients. We also make recommendations for areas of future research, which aim to improve understanding of the underlying processes and improve outcomes for patients with AKD.
Topics: Acute Kidney Injury; Humans; Remission Induction; Renal Insufficiency, Chronic
PubMed: 28239173
DOI: 10.1038/nrneph.2017.2 -
Nature Reviews. Nephrology Oct 2016Heart failure (HF) is a major health-care problem and the prognosis of affected patients is poor. HF often coexists with a number of comorbidities of which declining... (Review)
Review
Heart failure (HF) is a major health-care problem and the prognosis of affected patients is poor. HF often coexists with a number of comorbidities of which declining renal function is of particular importance. A loss of glomerular filtration rate, as in acute kidney injury (AKI) or chronic kidney disease (CKD), independently predicts mortality and accelerates the overall progression of cardiovascular disease and HF. Importantly, cardiac and renal diseases interact in a complex bidirectional and interdependent manner in both acute and chronic settings. From a pathophysiological perspective, cardiac and renal diseases share a number of common pathways, including inflammatory and direct, cellular immune-mediated mechanisms; stress-mediated and (neuro)hormonal responses; metabolic and nutritional changes including bone and mineral disorder, altered haemodynamic and acid-base or fluid status; and the development of anaemia. In an effort to better understand the important crosstalk between the two organs, classifications such as the cardio-renal syndromes were developed. This classification might lead to a more precise understanding of the complex interdependent pathophysiology of cardiac and renal diseases. In light of exceptionally high mortality associated with coexisting HF and kidney disease, this Review describes important crosstalk between the heart and kidney, with a focus on HF and kidney disease in the acute and chronic settings. Underlying molecular and cellular pathomechanisms in HF, AKI and CKD are discussed in addition to current and future therapeutic approaches.
Topics: Acute Kidney Injury; Animals; Cardio-Renal Syndrome; Heart; Heart Failure; Hemodynamics; Humans; Kidney; Neurotransmitter Agents; Renal Insufficiency, Chronic
PubMed: 27573728
DOI: 10.1038/nrneph.2016.113 -
Critical Care Clinics Apr 2021Acute kidney injury (AKI) and chronic kidney disease are common interconnected syndromes that represent a public health problem. Acute kidney disease (AKD) is defined as... (Review)
Review
Acute kidney injury (AKI) and chronic kidney disease are common interconnected syndromes that represent a public health problem. Acute kidney disease (AKD) is defined as the post-AKI status of acute or subacute kidney damage/dysfunction manifested by persistence of AKI beyond 7 to 90 days after the initial AKI diagnosis. Limited clinical data exist regarding AKD epidemiology but its incidence is observed in ∼25% of AKI survivors. Useful risk-stratification tools to predict risk of AKD and its prognosis are needed. Interventions on fluid management, nephrotoxic exposure, and follow-up care hold promise to ameliorate the burden of AKD and its complications.
Topics: Acute Disease; Acute Kidney Injury; Humans; Incidence; Prognosis; Renal Insufficiency, Chronic; Risk Factors
PubMed: 33752866
DOI: 10.1016/j.ccc.2020.11.013 -
Nature Reviews. Nephrology May 2021Mitochondria are essential for the activity, function and viability of eukaryotic cells and mitochondrial dysfunction is involved in the pathogenesis of acute kidney... (Review)
Review
Mitochondria are essential for the activity, function and viability of eukaryotic cells and mitochondrial dysfunction is involved in the pathogenesis of acute kidney injury (AKI) and chronic kidney disease, as well as in abnormal kidney repair after AKI. Multiple quality control mechanisms, including antioxidant defence, protein quality control, mitochondrial DNA repair, mitochondrial dynamics, mitophagy and mitochondrial biogenesis, have evolved to preserve mitochondrial homeostasis under physiological and pathological conditions. Loss of these mechanisms may induce mitochondrial damage and dysfunction, leading to cell death, tissue injury and, potentially, organ failure. Accumulating evidence suggests a role of disturbances in mitochondrial quality control in the pathogenesis of AKI, incomplete or maladaptive kidney repair and chronic kidney disease. Moreover, specific interventions that target mitochondrial quality control mechanisms to preserve and restore mitochondrial function have emerged as promising therapeutic strategies to prevent and treat kidney injury and accelerate kidney repair. However, clinical translation of these findings is challenging owing to potential adverse effects, unclear mechanisms of action and a lack of knowledge of the specific roles and regulation of mitochondrial quality control mechanisms in kidney resident and circulating cell types during injury and repair of the kidney.
Topics: Acute Kidney Injury; Animals; Humans; Mitochondria; Renal Insufficiency, Chronic
PubMed: 33235391
DOI: 10.1038/s41581-020-00369-0 -
The Annals of Pharmacotherapy Jan 2020To summarize current antibiotic dosing recommendations in critically ill patients receiving intermittent hemodialysis (IHD), prolonged intermittent renal replacement... (Review)
Review
Antibiotic Dosing for Critically Ill Adult Patients Receiving Intermittent Hemodialysis, Prolonged Intermittent Renal Replacement Therapy, and Continuous Renal Replacement Therapy: An Update.
To summarize current antibiotic dosing recommendations in critically ill patients receiving intermittent hemodialysis (IHD), prolonged intermittent renal replacement therapy (PIRRT), and continuous renal replacement therapy (CRRT), including considerations for individualizing therapy. A literature search of PubMed from January 2008 to May 2019 was performed to identify English-language literature in which dosing recommendations were proposed for antibiotics commonly used in critically ill patients receiving IHD, PIRRT, or CRRT. All pertinent reviews, selected studies, and references were evaluated to ensure appropriateness for inclusion. Updated empirical dosing considerations are proposed for antibiotics in critically ill patients receiving IHD, PIRRT, and CRRT with recommendations for individualizing therapy. This review defines principles for assessing renal function, identifies RRT system properties affecting drug clearance and drug properties affecting clearance during RRT, outlines pharmacokinetic and pharmacodynamic dosing considerations, reviews pertinent updates in the literature, develops updated empirical dosing recommendations, and highlights important factors for individualizing therapy in critically ill patients. Appropriate antimicrobial selection and dosing are vital to improve clinical outcomes. Dosing recommendations should be applied cautiously with efforts to consider local epidemiology and resistance patterns, antibiotic dosing and infusion strategies, renal replacement modalities, patient-specific considerations, severity of illness, residual renal function, comorbidities, and patient response to therapy. Recommendations provided herein are intended to serve as a guide in developing and revising therapy plans individualized to meet a patient's needs.
Topics: Adult; Anti-Bacterial Agents; Continuous Renal Replacement Therapy; Critical Illness; Female; Humans; Intermittent Renal Replacement Therapy; Kidney Function Tests; Male; Metabolic Clearance Rate; Middle Aged; Renal Dialysis; Renal Insufficiency
PubMed: 31342772
DOI: 10.1177/1060028019865873 -
Pediatric Nephrology (Berlin, Germany) Oct 2021Our aging population is growing and developing treatments for age-related diseases such as Alzheimer's and Parkinson's disease has taken on an increasing urgency and is... (Review)
Review
Our aging population is growing and developing treatments for age-related diseases such as Alzheimer's and Parkinson's disease has taken on an increasing urgency and is accompanied by high public awareness. The already high and rising incidence of acute kidney injury (AKI) in the elderly, however, has received relatively little attention despite the potentially fatal outcomes associated with an episode of AKI in this age group. When discussing AKI and aging, one should consider two aspects: first, elderly patients have an increased susceptibility to an AKI episode, and second, they have decreased kidney repair after AKI given the high incidence of progression to chronic kidney disease (CKD). It is unclear if the same factors that drive the increased susceptibility to AKI could be playing a role in the decreased repair capacity or if they are totally different and unrelated. This review will examine current knowledge on the risk factors for the increased susceptibility to AKI in the elderly and will also explore potential aspects that might contribute to a decreased kidney repair response in this age group.
Topics: Acute Kidney Injury; Aged; Aging; Disease Progression; Humans; Kidney; Renal Insufficiency, Chronic; Risk Factors
PubMed: 33411069
DOI: 10.1007/s00467-020-04849-0