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Seminars in Arthritis and Rheumatism Jun 2015To discuss the pathophysiology, risk factors, clinical manifestations, diagnosis, treatment, prevention, and outcomes of scleroderma renal crisis (SRC), a serious yet... (Review)
Review
OBJECTIVES
To discuss the pathophysiology, risk factors, clinical manifestations, diagnosis, treatment, prevention, and outcomes of scleroderma renal crisis (SRC), a serious yet potentially treatable complication of scleroderma (systemic sclerosis).
METHODS
A PubMed search for articles published up until April 2014 was conducted using the following keywords: scleroderma, systemic sclerosis, scleroderma renal crisis, renal, treatment, and prognosis. Literature was carefully reviewed, and different risk factors, treatment options, prognostic factors, and survival data were assessed.
RESULTS
SRC occurs in about 10% of all patients with scleroderma. It is characterized by malignant hypertension and progressive renal failure. Around 10% of SRC cases may present with normal blood pressure, termed normotensive renal crisis. The etiopathogenesis is presumed to be a series of insults to the kidneys resulting in endothelial injury, intimal proliferation, and narrowing of renal arterioles leading to decreased blood flow, hyperplasia of the juxtaglomerular apparatus, hyperreninemia, and accelerated hypertension. Risk factors include rapid skin thickening, use of certain medications such corticosteroids or cyclosporine, new-onset microangiopathic hemolytic anemia and/or thrombocytopenia, cardiac complications (pericardial effusion, congestive heart failure, and/or arrhythmias), large joint contractures, and presence of anti-RNA polymerase III antibody. Since the 1970s, with the advent of angiotensin-converting enzyme (ACE) inhibitors, mortality associated with SRC decreased from 76% to <10%. Some patients may progress to end-stage renal disease and need dialysis. Renal transplantation has improved survival, though SRC may recur in transplanted kidneys.
CONCLUSIONS
More than 60 years after its initial description, SRC still remains an important cause of morbidity and mortality in scleroderma. Since the advent of ACE inhibitors, the prognosis of SRC has improved substantially. Prompt diagnosis and treatment may help prevent adverse outcomes and improve survival.
Topics: Angiotensin-Converting Enzyme Inhibitors; Disease Progression; Humans; Hypertension, Malignant; Prognosis; Renal Dialysis; Renal Insufficiency; Risk Factors; Scleroderma, Systemic
PubMed: 25613774
DOI: 10.1016/j.semarthrit.2014.12.001 -
Endocrine-related Cancer Jan 2020Renal hyperparathyroidism (rHPT) is a complex and challenging disorder. It develops early in the course of renal failure and is associated with increased risks of... (Review)
Review
Renal hyperparathyroidism (rHPT) is a complex and challenging disorder. It develops early in the course of renal failure and is associated with increased risks of fractures, cardiovascular disease and death. It is treated medically, but when medical therapy cannot control the hyperparathyroidism, surgical parathyroidectomy is an option. In this review, we summarize the pathophysiology, diagnosis, and medical treatment; we describe the effects of renal transplantation; and discuss the indications and strategies in parathyroidectomy for rHPT. Renal hyperparathyroidism develops early in renal failure, mainly as a consequence of lower levels of vitamin D, hypocalcemia, diminished excretion of phosphate and inability to activate vitamin D. Treatment consists of supplying vitamin D and reducing phosphate intake. In later stages calcimimetics might be added. RHPT refractory to medical treatment can be managed surgically with parathyroidectomy. Risks of surgery are small but not negligible. Parathyroidectomy should likely not be too radical, especially if the patient is a candidate for future renal transplantation. Subtotal or total parathyroidectomy with autotransplantation are recognized surgical options. Renal transplantation improves rHPT but does not cure it.
Topics: Humans; Hyperparathyroidism; Parathyroidectomy; Renal Insufficiency; Transplantation, Autologous
PubMed: 31693488
DOI: 10.1530/ERC-19-0284 -
Seminars in Nephrology Sep 2023Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has led to a global pandemic that continues to be responsible for ongoing... (Review)
Review
Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has led to a global pandemic that continues to be responsible for ongoing health issues for people worldwide. Immunocompromised individuals such as kidney transplant recipients and dialysis patients have been and continue to be among the most affected, with poorer outcomes after infection, impaired response to COVID-19 vaccines, and protracted infection. The pandemic also has had a significant impact on patients with underlying chronic kidney disease (CKD), with CKD increasing susceptibility to COVID-19, risk of hospital admission, and mortality. COVID-19 also has been shown to lead to acute kidney injury (AKI) through both direct and indirect mechanisms. The incidence of COVID-19 AKI has been decreasing as the pandemic has evolved, but continues to be associated with adverse patient outcomes correlating with the severity of AKI. There is also increasing evidence examining the longer-term effect of COVID-19 on the kidney demonstrating continued decline in kidney function several months after infection. This review summarizes the current evidence examining the impact of COVID-19 on the kidney, covering both the impact on patients with CKD, including patients receiving kidney replacement therapy, in addition to discussing COVID-19 AKI.
Topics: Humans; COVID-19; COVID-19 Vaccines; Kidney; Renal Insufficiency, Chronic; Acute Kidney Injury
PubMed: 38199827
DOI: 10.1016/j.semnephrol.2023.151471 -
Lakartidningen Mar 2023Hyperkalemia is a relatively common electrolyte abnormality that in serious cases can lead to life-threatening arrhythmias. There are a number of factors that can...
Hyperkalemia is a relatively common electrolyte abnormality that in serious cases can lead to life-threatening arrhythmias. There are a number of factors that can contribute to hyperkalemia, and in most cases some level of kidney failure is present. The management of hyperkalemia depends on the underlying cause and the level of potassium. This paper briefly examines the pathophysiological mechanisms behind hyperkalemia, with a special focus on treatment.
Topics: Humans; Hyperkalemia; Potassium; Renal Insufficiency; Arrhythmias, Cardiac
PubMed: 36912790
DOI: No ID Found -
Annales D'endocrinologie Jun 2021FGF23 is a protein secreted in the plasma by bone cells. In the kidney, FGF23 can activate an FGF receptor in the presence of its co-receptor αKlotho. FGF23 controls... (Review)
Review
FGF23 is a protein secreted in the plasma by bone cells. In the kidney, FGF23 can activate an FGF receptor in the presence of its co-receptor αKlotho. FGF23 controls the renal phosphate reabsorption and calcitriol metabolism. When renal function declines, plasma FGF23 concentration raises and FGF23 can stimulate FGFRs in the absence of αKlotho. This induces cardiac hypertrophy, modifies cardiomyocyte contractility and increases the risk of arrhythmic events in cardiac cells. There is still no evidence that decreasing FGF23 concentration in patients on dialysis could improve their survival. In different cardiac disorders cardiomyocyte can produce FGF23, which can reveal a way of adaptation to the stress.
Topics: Animals; Cardiovascular Diseases; Fibroblast Growth Factor-23; Heart Disease Risk Factors; Humans; Kidney; Phosphates; Renal Insufficiency; Risk Factors; Signal Transduction
PubMed: 32950228
DOI: 10.1016/j.ando.2020.03.007 -
Nephrologie & Therapeutique Feb 2020
Topics: Humans; Renal Insufficiency
PubMed: 32241526
DOI: 10.1016/S1769-7255(20)30070-5 -
The Veterinary Clinics of North... Mar 2019Stem cell therapy has tremendous potential for clinical application in the treatment of a variety of diseases in veterinary medicine. Based on the known desirable... (Review)
Review
Stem cell therapy has tremendous potential for clinical application in the treatment of a variety of diseases in veterinary medicine. Based on the known desirable immunomodulatory properties of mesenchymal stem cells, this therapy has potential for treatment of a variety of renal diseases. This review details our current understanding of stem cell biology and proposed mechanism of action as applicable to renal disease. Studies performed in chronic kidney disease clinical trials and models of acute kidney injury are summarized with the goal of providing an overview of the current status of this treatment modality and its potential for the future.
Topics: Acute Kidney Injury; Animals; Cat Diseases; Cats; Dog Diseases; Dogs; Mesenchymal Stem Cells; Renal Insufficiency, Chronic; Veterinary Medicine
PubMed: 30591191
DOI: 10.1016/j.cvsm.2018.10.001 -
Endocrinology and Metabolism (Seoul,... Apr 2022
Topics: Female; Humans; Hyperthyroidism; Male; Renal Insufficiency
PubMed: 35504599
DOI: 10.3803/EnM.2022.201 -
Journal of Veterinary Internal Medicine Nov 2020Chronic kidney disease (CKD) and acute exacerbation of CKD (ACKD) are common in dogs.
BACKGROUND
Chronic kidney disease (CKD) and acute exacerbation of CKD (ACKD) are common in dogs.
OBJECTIVE
To characterize the etiology, clinical and laboratory findings, and short- and long-term prognosis of dogs with ACKD.
ANIMALS
One hundred dogs with ACKD.
METHODS
Medical records of dogs diagnosed with ACKD admitted to a veterinary teaching hospital were retrospectively reviewed.
RESULTS
The most common clinical signs included anorexia (84%), lethargy (77%), vomiting (55%) and diarrhea (37%). Presumptive etiology included inflammatory causes (30%), pyelonephritis (15%), ischemic causes (7%), other (3%), or unknown (45%). Median hospitalization time was 5 days (range, 2-29 days) and was significantly longer in survivors (6 days; range, 2-29 days) compared with nonsurvivors (4 days; range, 2-20 days; P < .001). Mortality rate was 35%. International Renal Interest Society (IRIS) acute kidney injury (AKI) grade at presentation was associated (P = .009) with short-term survival, but presumptive etiology was not (P = .46). On multivariable analysis; respiratory rate (P = .01), creatine kinase (CK) activity (P = .005) and serum creatinine concentration (SCR; P = .04) at presentation were associated with short-term outcome. Median survival time of dogs discharged was 105 days (95% confidence interval [CI], 25-184), with 35 and 8 dogs surviving up to 6 and 12 months, respectively. Presumptive etiology (P = .16) and SCR (P = .59) at discharge were not predictors of long-term survival.
CONCLUSION AND CLINICAL IMPORTANCE
Short-term outcome of dogs with ACKD is comparable to those with AKI but long-term prognosis is guarded. The IRIS AKI grade at presentation is a prognostic indicator of short-term outcome.
Topics: Acute Kidney Injury; Animals; Dog Diseases; Dogs; Hospitals, Animal; Hospitals, Teaching; Prognosis; Renal Insufficiency, Chronic; Retrospective Studies
PubMed: 33044036
DOI: 10.1111/jvim.15931 -
American Journal of Kidney Diseases :... Aug 2018
Topics: Humans; Kidney Transplantation; Paintings; Peritoneal Dialysis; Renal Insufficiency
PubMed: 29903657
DOI: 10.1053/j.ajkd.2018.05.003