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Current Opinion in Nephrology and... May 2002While it is clear that malignant hypertension damages the kidneys, the question of whether non-malignant hypertension actually causes renal insufficiency remains... (Review)
Review
While it is clear that malignant hypertension damages the kidneys, the question of whether non-malignant hypertension actually causes renal insufficiency remains controversial. A recent meta-analysis of 10 randomized controlled trials of antihypertensive drug therapy showed that patients randomized to antihypertensive therapy (or more-intensive therapy) did not show a significant reduction in their risk of developing renal dysfunction (relative risk, 0.97; 95% confidence interval, 0.78-1.21; P=0.77). A review of the totality of the evidence shows that there is relatively weak support for the thesis that non-malignant hypertension itself is an important de-novo cause (initiator) of renal insufficiency (as opposed to being a promoter of existing renal disease, which is a well established fact). Failure to evaluate the possibility that pre-existing renal disease could explain any observed association between elevated blood pressure and subsequent loss of renal function is an important limitation of published studies.
Topics: Evidence-Based Medicine; Humans; Hypertension; Randomized Controlled Trials as Topic; Renal Insufficiency
PubMed: 11981255
DOI: 10.1097/00041552-200205000-00001 -
Pediatrics in Review Feb 2023
Topics: Male; Humans; Child; Renal Insufficiency; Vision Disorders
PubMed: 36720685
DOI: 10.1542/pir.2021-005132 -
Continuum (Minneapolis, Minn.) Jun 2017Neurologic dysfunction is prevalent in patients with acute and chronic renal disease and may affect the central nervous system, peripheral nervous system, or both.... (Review)
Review
PURPOSE OF REVIEW
Neurologic dysfunction is prevalent in patients with acute and chronic renal disease and may affect the central nervous system, peripheral nervous system, or both. Neurologic manifestations may result directly from the uremic state or as a consequence of renal replacement therapy. Early recognition of neurologic dysfunction may provide opportunities for intervention and reduced morbidity.
RECENT FINDINGS
Advances in the understanding of neurologic complications of renal disease and its treatments have led to more widespread recognition and earlier identification of encephalopathy syndromes such as cefepime neurotoxicity and posterior reversible encephalopathy syndrome (PRES), dramatic reductions in the incidence of dialysis disequilibrium syndrome and dialysis dementia, and improved survival in disorders such as von Hippel-Lindau disease and thrombotic thrombocytopenic purpura.
SUMMARY
This article summarizes the conditions that affect both the renal and the nervous systems, the effects of renal failure on the nervous system, and the neurologic complications of dialysis.
Topics: Adult; Brain Diseases; Humans; Intracranial Aneurysm; Male; Posterior Leukoencephalopathy Syndrome; Renal Dialysis; Renal Insufficiency
PubMed: 28570326
DOI: 10.1212/CON.0000000000000469 -
The American Journal of Medicine Dec 2006The United States is currently beleaguered by twin epidemics, heart failure (HF) and renal insufficiency (RI). HF and RI frequently coexist in the same patient, and this... (Review)
Review
The United States is currently beleaguered by twin epidemics, heart failure (HF) and renal insufficiency (RI). HF and RI frequently coexist in the same patient, and this conjunction, often called the "cardiorenal syndrome," has important therapeutic and prognostic implications. Approximately 60% to 80% of patients hospitalized for HF have at least stage III renal dysfunction as defined by the National Kidney Foundation (NKF), and this comorbid RI is associated with significantly increased morbidity and mortality risk. Numerous studies have demonstrated that in patients with HF, indices of renal function are the most powerful independent mortality risk predictors. Comorbid RI can result from both intrinsic renal disease and inadequate renal perfusion. Atherosclerosis, renal vascular disease, diabetes mellitus, and hypertension are significant precursors of both HF and RI. Moreover, diminished renal perfusion is frequently a consequence of the hemodynamic changes associated with HF and its treatment. Both HF and RI stimulate neurohormonal activation, increasing both preload and afterload and reducing cardiac output. Inotropic agents augment this neurohormonal activation. In addition, diuretics can produce hypovolemia and intravenous vasodilators can cause hypotension, further diminishing renal perfusion. Management of these patients requires successfully negotiating the delicate balance between adequate volume reduction and worsening renal function. Despite this, few evidence-based data are available to guide management decisions, indicating a compelling need for additional studies in this patient population.
Topics: Acute Disease; Cardiac Output, Low; Comorbidity; Prognosis; Renal Insufficiency; Syndrome
PubMed: 17113396
DOI: 10.1016/j.amjmed.2006.09.013 -
Cardiovascular Drugs and Therapy Dec 2002Chronic renal failure and arterial hypertension run in parallel. New goal blood pressure levels have been established in 130/85 mmHg and 125/75 mmHg depending on the... (Review)
Review
Chronic renal failure and arterial hypertension run in parallel. New goal blood pressure levels have been established in 130/85 mmHg and 125/75 mmHg depending on the level of proteinuria being below or above 1 g/day. New and lower threshold BP (>130/85 mmHg) to initiate pharmacologic therapy are required in the presence of renal failure in order to facilitate the strict BP control that is required. Renal insufficiency is accompanied since its initial stages by a marked increase in cardiovascular risk and serum creatinine, its estimated clearance and the presence of proteinuria are very powerful predictors of a bad cardiovascular outcome. Hence, the need to consider that both renal and cardiovascular protection are obtained with such a strict BP control which, otherwise seems to require blockade of angiotensin II effects when proteinuria above 1g/day is present. Prevention of renal failure related to elevated blood pressure requires of strict blood pressure control, usually obtained with combination of two or more antihypertensive agents, one of them capable of blocking angiotensin II. Besides this, strict control of associated cardiovascular risk factors is also required.
Topics: Angiotensin-Converting Enzyme Inhibitors; Calcium Channel Blockers; Cardiovascular Agents; Humans; Renal Insufficiency; Risk Factors
PubMed: 12766382
DOI: 10.1023/a:1022917827596 -
Progressive renal insufficiency. Office strategies to prevent or slow progression of kidney disease.Postgraduate Medicine Jul 2000Prevention of chronic renal failure should be a primary healthcare goal in the new millennium. Better control of blood pressure, blood glucose, and lipid levels shows... (Review)
Review
Prevention of chronic renal failure should be a primary healthcare goal in the new millennium. Better control of blood pressure, blood glucose, and lipid levels shows promise for slowing and perhaps even preventing renal dysfunction. Protein-sparing diets also may prove to be important. While it is not yet known whether combining interventions to treat each of these factors will have additive or synergistic effects, it seems prudent to approach these problems aggressively.
Topics: Dietary Proteins; Hemodynamics; Humans; Hyperlipidemias; Kidney Failure, Chronic; Proteinuria; Renal Insufficiency; Risk Factors
PubMed: 10914124
DOI: 10.3810/pgm.2000.07.1153 -
International Urology and Nephrology Jan 2022Despite the severity of ethylene glycol intoxication, there is a paucity of studies that analyze prognostic factors. This study aims to determine prognostic factors with...
BACKGROUND
Despite the severity of ethylene glycol intoxication, there is a paucity of studies that analyze prognostic factors. This study aims to determine prognostic factors with impact on core outcomes like death and prolonged kidney injury (KI) in ethylene glycol poisoned patients.
METHODS
We retrospectively assessed prevalence, clinical and biochemical features in one large data set from two regional hospitals from the North-East region of Romania, between January 2012 and October 2017. Secondly, we compared prognostic factors of cases treated with dialysis plus antidote (Nā=ā28 patients) with cases who received antidote only and supportive therapy (Nā=ā28 patients).
RESULTS
Of the 56 cases included, 16 deaths (28.57%) were recorded. The symptomatology at admission was more severe among patients requiring hemodialysis: a lower mean value for initial pH, lower initial alkaline reserve (AR) and higher mean values for initial serum creatinine (Cr1). The data analysis (survivors/deceased) showed a correlation between pH, Glasgow Coma Score (GCS), and increased mortality. In addition, we found a correlation between initial mean values for pH, AR (mmol/L), Cr1 (mg/dL), and peak Cr24 (mg/dL) with outcomes of RI or death.
CONCLUSIONS
Compared with survivors, patients who died or had prolonged kidney injury were more likely to exhibit clinical signs such as coma, seizures, and acidosis. Hemodialysis and antidote should be started early and continued until acidosis is corrected.
Topics: Adult; Aged; Aged, 80 and over; Ethylene Glycol; Female; Humans; Male; Middle Aged; Prevalence; Prognosis; Renal Insufficiency; Retrospective Studies; Time Factors; Young Adult
PubMed: 33738645
DOI: 10.1007/s11255-021-02837-3 -
Cleveland Clinic Journal of Medicine Jun 2006Earlier detection of edema and renal insufficiency, before overt decompensation, is fundamental to further advances in altering the natural history of heart failure.... (Review)
Review
Earlier detection of edema and renal insufficiency, before overt decompensation, is fundamental to further advances in altering the natural history of heart failure. Progress is being made in the earlier detection of these complications through the use of new devices that monitor for hemodynamic compromise and through monitoring of select cardiac and renal biomarkers. In addition, diuretic-sparing approaches to heart failure management, novel drug classes, new devices, and nonpharmacologic therapies are emerging to reduce reliance on diuretic therapy and manage edema with less renal compromise.
Topics: Biomarkers; Cystatin C; Cystatins; Disease Progression; Edema; Heart Failure; Humans; Renal Insufficiency; Troponin T
PubMed: 16786908
DOI: 10.3949/ccjm.73.suppl_2.s14 -
International Journal of Cardiology Jan 2021We aimed to analyze the association of estimated glomerular filtration rate (eGFR) levels of hospitalized patients with treatment decisions and clinical outcomes in...
BACKGROUND
We aimed to analyze the association of estimated glomerular filtration rate (eGFR) levels of hospitalized patients with treatment decisions and clinical outcomes in Chinese patients with acute coronary syndrome (ACS).
METHODS
This was a secondary analysis study from CPACS-2 Program which was a trial of a quality improvement intervention in China and recruited 15,141 patients from 75 hospitals between October 2007 and August 2010. All patients were divided into three groups by the eGFR level on admission. The primary outcomes were several key performance indicators (KPIs) reflecting the management of ACS and the secondary outcomes were clinical outcomes.
RESULTS
A total of 14,437 ACS patients were enrolled in this analysis. Among patients with reduced eGFR levels, fewer patients received appropriate medical therapy (p for trend <0.001) and fewer high-risk patients received coronary angiography (p for trend <0.001) compared to patients with a normal eGFR. Furthermore, 436 cases of death, 357 cases of cardiac death, 686 cases of major adverse cardiovascular events, and 198 cases of major bleeding episodes were reported. Patients with a worse eGFR level had significantly higher rates of death (p for trend <0.001), cardiac death (p for trend <0.001), major adverse cardiovascular events (p for trend <0.001) and major bleeding episodes (p for trend <0.001).
CONCLUSION
Among Chinese ACS patients, those with renal insufficiency have a lower percentage of adherence to guideline-recommended treatments and worse clinical prognosis. Renal insufficiency is an important factor affecting guideline implementation in Chinese ACS patients.
CLINICAL TRIAL REGISTRATION
http://www.anzctr.org.au/default.aspx. Unique identifier: ACTRN12609000491268.
Topics: Acute Coronary Syndrome; China; Humans; Percutaneous Coronary Intervention; Renal Insufficiency; Treatment Outcome
PubMed: 32810549
DOI: 10.1016/j.ijcard.2020.08.022 -
Nephrologie & Therapeutique Feb 2020
Topics: Humans; Renal Insufficiency
PubMed: 32241526
DOI: 10.1016/S1769-7255(20)30070-5