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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 -
Endocrinology and Metabolism (Seoul,... Apr 2022
Topics: Female; Humans; Hyperthyroidism; Male; Renal Insufficiency
PubMed: 35504599
DOI: 10.3803/EnM.2022.201 -
The Medical Clinics of North America Sep 2001The poor clinical outcomes associated with postoperative HARI necessitate increased vigilance for HARI detection and intervention to minimize the progression to dialysis... (Review)
Review
The poor clinical outcomes associated with postoperative HARI necessitate increased vigilance for HARI detection and intervention to minimize the progression to dialysis dependency. Patient survival significantly worsens if HARI requires the initiation of dialysis. Postoperative changes, including intravascular volume expansion, SIRS, and reduced lean body mass, frequently confound the detection of HARI. Serum creatinine levels frequently do not reflect the decreased renal function because creatinine production rate is decreased with reduced lean body mass, and the serum creatinine concentration is reduced by increased intravascular volume expansion and increased volume of distribution associated with anasarca. Additional indices of renal function must be used postoperatively, including urine output, net volume status, urinalysis with microscopic examination of the spun pellet, and corrected estimations of creatinine clearance. Few therapeutic interventions currently exist to reverse HARI other than optimization of renal perfusion and limitation of nephrotoxin exposure. Dialysis remains a cornerstone of maintenance therapy for refractory and severe HARI. Selection of dialysis modality continues to be based on modality availability and patient stability.
Topics: Blood Volume; Glomerular Filtration Rate; Humans; Kidney Function Tests; Postoperative Complications; Renal Insufficiency
PubMed: 11565497
DOI: 10.1016/s0025-7125(05)70375-8 -
Seminars in Cardiothoracic and Vascular... Sep 2004The new millennium ushered in a number of changes in cardiac surgery. Off-pump coronary artery bypass surgery became technically easier so that multivessel surgery... (Review)
Review
The new millennium ushered in a number of changes in cardiac surgery. Off-pump coronary artery bypass surgery became technically easier so that multivessel surgery became less of a challenge and cardiologists were supplied with new catheters that accessed lesions that were previously thought of as being unapproachable. New drugs were introduced that made the management of heart failure patients feasible on an outpatient basis, and new devices extend the bridging period to transplantation. However, these advances have not necessarily been attended by significant improvements in outcome, possibly because the less challenging a procedure becomes, the sicker the patients that can be managed. This observation is particularly true with the incidence and outcome of renal failure after cardiac surgery. Bypass factors have been manipulated without much effect, and the traditional drugs that were found to increase renal blood flow in animal experiments did not translate into clinical improvement in renal outcome. Recent research has given us insight into the pathophysiology of ischemic acute renal failure, and it has been found that the paradigm was not as simple as previously thought, possibly accounting for the failure of the more traditional renal drugs (dopamine, mannitol and diuretics). However, these new insights open up the possibility of novel targets for renal protection and repair.
Topics: Cardiac Surgical Procedures; Humans; Postoperative Complications; Renal Circulation; Renal Insufficiency; Renal Replacement Therapy
PubMed: 15375482
DOI: 10.1177/108925320400800305 -
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 -
Clinical Nephrology Jul 1996Prevalence of renal insufficiency and renal failure of newborns in an intensive care unit is considerably high. Most patients have prerenal failure which is associated... (Review)
Review
Prevalence of renal insufficiency and renal failure of newborns in an intensive care unit is considerably high. Most patients have prerenal failure which is associated with the underlying disease, some have had heart surgery and only few patients have congenital renal malformation. In a retrospective analysis in our institution main risk factors were: prematurity, age < 10 days, obstetric complications, male gender, Cesarean delivery and pulmonary disease. We could not confirm, however, that asphyxia is significant for renal failure. Much more common than manifest renal failure is renal insufficiency in diseased newborns during intensive care. The cause is sometimes primary renal insufficiency as a harbinger of renal failure, but it is often iatrogenic, because fluid intake is inadequate, either unintentional or for a purpose. This strategy, however, conflicts with a conservative approach to renal insufficiency, which requires adequate fluid and caloric intake. A skilled approach to this situation demands a daily re-evaluation of the fluid regimen with regard to possible liberalization. If renal failure progresses dialysis may be indicated, but this remains controversial in neonates. However, with growing expertise, skill and adequate equipment, different techniques of dialysis nowadays can be applied even to small infants. Mortality in infants with acute renal failure ranges from 25 to 78%, but death is seldom caused primarily by renal disease. In our survey 0.9% in a total of 34% mortality was attributed to renal disease. Attention has to be paid to the bulk of diseased newborns, who experience only slight increase in serum creatinine in their early life with only mild (or even without) oliguria, who may be prone to residual renal morbidity as well as those, who have manifest renal failure.
Topics: Humans; Incidence; Infant, Newborn; Intensive Care Units, Neonatal; Male; Prognosis; Renal Insufficiency; Risk Factors; Sex Factors; Survival Rate
PubMed: 8832153
DOI: No ID Found -
Journal of Vascular Surgery Jan 2022
Topics: Glomerular Filtration Rate; Humans; Kidney; Racial Groups; Renal Insufficiency; Surgeons; United States
PubMed: 34949382
DOI: 10.1016/j.jvs.2021.10.023 -
Hematology. American Society of... 2010Renal impairment is a common complication of multiple myeloma. Chronic renal failure is classified according to glomerular filtration rate as estimated by the MDRD...
Renal impairment is a common complication of multiple myeloma. Chronic renal failure is classified according to glomerular filtration rate as estimated by the MDRD (modification of diet in renal disease) formula, while RIFLE (risk, injury, failure, loss and end-stage renal disease) and AKIN (acute renal injury network) criteria may be used for the definition of the severity of acute renal injury. Novel criteria based on estimated glomerular filtration rate measurements are proposed for the definition of the reversibility of renal impairment. Renal complete response (CRrenal) is defined as sustained (i.e., lasting at least 2 months) improvement of creatinine clearance (CRCL) from under 50 mL/min at baseline to 60 mL/min or above. Renal partial response (PRrenal) is defined as sustained improvement of CRCL from under 15 mL/min at baseline to 30 to 59 mL/min. Renal minor response (MRrenal) is defined as sustained improvement of the baseline CRCL of under 15 mL/min to 15 to 29 mL/min or, if baseline CRCL was 15 to 29 mL/min, improvement to 30 to 59 mL/min. Bortezomib with high-dose dexamethasone is considered the treatment of choice for myeloma patients with renal impairment and improves renal function in most patients. Although there is limited experience with thalidomide, this agent can be administered at the standard dosage to patients with renal failure. Lenalidomide, when administered at reduced doses according to renal function, is effective and can reverse renal impairment in a subset of myeloma patients.
Topics: Humans; Kidney Failure, Chronic; Multiple Myeloma; Prognosis; Renal Insufficiency
PubMed: 21239831
DOI: 10.1182/asheducation-2010.1.431 -
Clinical Pharmacokinetics Jan 1997Normal renal function is important for the excretion and metabolism of many drugs. Renal diseases which affect glomerular blood flow and filtration, tubular secretion,... (Review)
Review
Normal renal function is important for the excretion and metabolism of many drugs. Renal diseases which affect glomerular blood flow and filtration, tubular secretion, reabsorption and renal parenchymal mass alter drug clearances and lead to the need for alterations in dosage regimens to optimise therapeutic outcome and minimise the risk of toxicity. Renal disease is increasing and the cost of care has risen progressively over the past decade. Part of these costs is related to inappropriate drug therapy and excessive drug use. Although there are a variety of methods for evaluating the various aspects of renal function, the most practical and commonly used clinical measure of renal function is estimated creatinine clearance (CLCR) as a marker for glomerular filtration. This is useful since alterations in drug clearance are proportional to alterations in CLCR, and this relationship is used as the basis for changing doses and dosage intervals for drugs which are largely renally excreted. Two populations, neonates and the elderly, are at risk of inappropriate drug dosage due to physiological changes in renal function. Estimated CLCR may not be the best method of evaluating renal function in these patients, and dosage regimens should be carefully considered. Renal insufficiency and concurrent drug therapy used in these populations can either increase or decrease drug absorption, depending on the particular agent. Drug distribution may be altered in renal insufficiency due to pH-dependent protein binding and reduced protein (primarily albumin) levels. Interestingly, renal disease may affect hepatic as well as renal drug metabolism; the exact mechanisms for these changes are not well understood. The most important quantitative pharmacokinetic change is excretion. Glomerular filtration and tubular process may both be affected but not to the same extent, and the type of renal disease may differentially affect filtration and excretion. Drug removal by dialysis is dependent on a number of factors, including the characteristics of a particular drug and the type of dialysis and equipment used. Therapeutic outcomes may be evaluated using end-points such as plasma concentrations, patient outcomes such as reduction in fever or negative cultures, and system-wide changes such as drug-use or laboratory-use patterns.
Topics: Humans; Kidney; Pharmaceutical Preparations; Pharmacokinetics; Renal Insufficiency; Renal Replacement Therapy; United States
PubMed: 9012555
DOI: 10.2165/00003088-199732010-00002 -
Current Opinion in Nephrology and... Sep 2005This review focuses on the pathophysiology and treatment of an increasingly common entity, cardio-renal insufficiency. Cardio-renal insufficiency is more than a... (Review)
Review
PURPOSE OF REVIEW
This review focuses on the pathophysiology and treatment of an increasingly common entity, cardio-renal insufficiency. Cardio-renal insufficiency is more than a simultaneous cardiac and renal disease. Patients with this condition live within a fragile equilibrium challenged by the interaction of profibrogenic, atherosclerotic, neurohumoral, and other less known factors. Regarding therapy, the avoidance of oscillations between overfilled-decompensated and emptied-overtreated states becomes of critical importance. Particular focus should be paid to personalized treatment, adjusted according to heart and kidney reserve, the predictable complications of therapy, prevention of decompensations, simple measures-based follow-up and alternative procedures.
RECENT FINDINGS
Recent studies have established the important repercussions of unbalanced renal function on cardiovascular prognosis. In the heart failure setting, trials involving extensive cohorts of ageing or comorbidity-affected patients are presently under way. Special attention should be paid to recognize the presence of renal failure coexisting with heart failure, especially in patients with deceivingly near-normal plasma creatinine. Formulae to predict creatinine clearance are being increasingly incorporated into daily clinical practice. Disturbed renal function is an underappreciated prognostic factor in heart failure, and renal failure is frequently viewed as a relative contraindication to some proven efficacious therapies.
SUMMARY
Cardio-renal insufficiency is an emerging entity, with affected individuals surviving with extreme degrees of simultaneous heart failure and renal failure. Management of the condition is an intellectually demanding process. Crucial to this management is extensive medical expertise and an in-depth understanding of the particular renal, haemodynamic and internal milieu equilibrium of the patients.
Topics: Anemia; Cardiovascular Agents; Heart Failure; Humans; Hyperkalemia; Kidney; Prognosis; Renal Insufficiency; Renal Replacement Therapy
PubMed: 16046902
DOI: 10.1097/01.mnh.0000170753.41279.70