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Seminars in Nephrology Jul 2017Women with chronic kidney disease (CKD) are at risk for adverse pregnancy-associated outcomes, including progression of their underlying renal dysfunction, a flare of... (Review)
Review
Women with chronic kidney disease (CKD) are at risk for adverse pregnancy-associated outcomes, including progression of their underlying renal dysfunction, a flare of their kidney disease, and adverse pregnancy complications such as preeclampsia and preterm delivery. Earlier-stage CKD, as a rule, is a safer time to have a pregnancy, but even women with end-stage kidney disease have attempted pregnancy in recent years. As such, nephrologists need to be comfortable with pregnancy preparation and management at all stages of CKD. In this article, we review the renal physiologic response to pregnancy and the literature with respect to both expected maternal and fetal outcomes among young women at various stages of CKD, including those who attempt to conceive while on dialysis. The general management of young women with CKD and associated complications, including hypertension and proteinuria are discussed. Finally, the emotional impact these pregnancies may have on young women with a chronic disease and the potential benefits of care in a multidisciplinary environment are highlighted.
Topics: Adaptation, Physiological; Directive Counseling; Female; Humans; Hypertension; Kidney Failure, Chronic; Kidney Glomerulus; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy, High-Risk; Proteinuria; Renal Dialysis; Renal Insufficiency; Risk Assessment
PubMed: 28711072
DOI: 10.1016/j.semnephrol.2017.05.005 -
Leukemia & Lymphoma Jun 2021Clinical trials may be inconsistent in their enrollment and reporting of patients with multiple myeloma (MM) who have renal insufficiency (RI). We performed a systematic... (Meta-Analysis)
Meta-Analysis
Clinical trials may be inconsistent in their enrollment and reporting of patients with multiple myeloma (MM) who have renal insufficiency (RI). We performed a systematic review of all MM randomized clinical trials (RCT) from 2005-2019 to evaluate reporting of prevalence, eligibility criteria and outcomes of patients with RI and MM. One-hundred and twenty-three RCTs were included. Only 30% of studies clearly reported on the proportion of patients who had RI. Only 68.2% reported eligibility criteria pertaining to RI, with no uniformity in the reported criteria. The relative risk (RR) of disease progression or death in patients with RI was higher than those without, RR of 1.20 (1.003-1.431) for relapsed/refractory and 1.07 (1.001-1.046) for newly diagnosed. There is inconsistent reporting and enrollment of patients with RI on MM RCT's. We advocate for higher enrollment of patients with RI and transparent reporting of their eligibility criteria and outcomes.
Topics: Humans; Multiple Myeloma; Randomized Controlled Trials as Topic; Renal Insufficiency
PubMed: 33416412
DOI: 10.1080/10428194.2020.1867725 -
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 -
The Journal of Thoracic and... Dec 2022
Topics: Humans; Child; Heart Transplantation; Renal Insufficiency; Waiting Lists; Heart Failure
PubMed: 35115139
DOI: 10.1016/j.jtcvs.2022.01.002 -
Liver Transplantation : Official... May 2008
Review
Topics: Creatinine; Diabetes Complications; Disease Progression; Glomerular Filtration Rate; Humans; Kidney Failure, Chronic; Kidney Transplantation; Liver Diseases; Liver Transplantation; Patient Selection; Recovery of Function; Renal Dialysis; Renal Insufficiency; Research Design; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 18433066
DOI: 10.1002/lt.21454 -
Medicine Mar 2017With the continuous development of cardiac interventional medicine, the incidence of contrast-induced nephropathy (CIN) is increasing every year, which is a serious... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
With the continuous development of cardiac interventional medicine, the incidence of contrast-induced nephropathy (CIN) is increasing every year, which is a serious threat to people's physical and mental health. Trimetazidine (TMZ) is a type of anti-ischemic drug developed in recent years, which can significantly reduce the incidence of CIN. At present, a systematic review and meta-analysis was conducted to evaluate the clinical effect of TMZ on prevention of CIN in patients with renal insufficiency. However, the study did not include patients from other countries and speaking different languages. So we conducted this study to update the previous meta-analysis that investigated the effects of TMZ on prevention of CIN in patients with renal insufficiency, and provided some theoretical reference for clinical.
METHODS
By searching PubMed, Embase, the Cochrane Library, Web of Science, CBM, CNKI, VIP database, and Wang Fang database for randomized controlled trial, which is comparing TMZ versus conventional hydration for prevention of CIN. Two researchers independently screened literature, and then evaluated the quality of literature and extracted the relevant data. Stata 11.0 software was used for statistical analysis.
RESULTS
Finally, this updated review showed that 3 studies that were not included in the previous meta-analysis were included in our study (3 articles were published in the Chinese Journal, 1 study for CIN, 1 study for CIN, serum creatinine (Scr), and superoxide dismutase, 1 study for CIN and Scr), and 1 outcome (Scr) reflecting the change of renal function was additionally included in our study. Of the 932 studies, 6 randomized controlled trials met the criteria, including 377 patients in TMZ group and 387 patients in control group. This meta-analysis for all studies showed that TMZ can significantly reduce the incidence of CIN (relative risk 0.27, 95% confidence interval [CI] 0.16, 0.46, P = 0.000), and can decrease the level of Scr after operation, including Scr of postoperative 24 hours (standardized mean difference [SMD] -0.30, 95% CI -0.51, -0.09, P = 0.005), Scr of postoperative 48 hours (SMD -0.66, 95% CI -1.23, -0.10, P = 0.022), and Scr of postoperative 7 days (SMD -0.74, 95% CI -1.36, -0.11, P = 0.021). However, the Scr of postoperative 72 hours between TMZ group and control group has no statistical significance (P = 0.362).
CONCLUSION
Our study showed that when comparing with conventional hydration, TMZ can significantly reduce the incidence of CIN and the level of postoperative Scr. Therefore, we could suggest that TMZ was superior to conventional hydration for the treatment of CIN in patients with renal insufficiency. However, due to the restriction of quality and number of included articles, it still needs to carry out multicenter, randomized, double-blind clinical trials to confirm this conclusion in the future.
Topics: Contrast Media; Creatinine; Humans; Incidence; Renal Insufficiency; Trimetazidine; Vasodilator Agents
PubMed: 28248861
DOI: 10.1097/MD.0000000000006059 -
International Journal of Cardiology Apr 2021
Topics: Acute Coronary Syndrome; China; Glomerular Filtration Rate; Humans; Renal Insufficiency
PubMed: 33388400
DOI: 10.1016/j.ijcard.2020.12.069 -
The New England Journal of Medicine Jun 2022
Review
Topics: Acute Disease; Albuminuria; Glomerular Filtration Rate; Humans; Renal Insufficiency; Renal Insufficiency, Chronic
PubMed: 35648704
DOI: 10.1056/NEJMra2201153 -
Thrombosis Research 2006
Review
Topics: Hemorrhage; Humans; Practice Guidelines as Topic; Practice Patterns, Physicians'; Renal Insufficiency
PubMed: 15975636
DOI: 10.1016/j.thromres.2005.03.029 -
Der Internist Jul 2012
Topics: Cardiovascular Diseases; Humans; Renal Insufficiency
PubMed: 22714580
DOI: 10.1007/s00108-011-2980-7