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Prilozi (Makedonska Akademija Na... Nov 2016The incidence of chronic kidney disease (CKD) in patients with chronic heart failure (CHF) is high as CKD and CHF share underlying risk factors such as arterial... (Review)
Review
The incidence of chronic kidney disease (CKD) in patients with chronic heart failure (CHF) is high as CKD and CHF share underlying risk factors such as arterial hypertension, diabetes mellitus and atherosclerosis. Cardiac failure leads to renal hypoperfusion and dysfunction and then fluid overload and need for aggressive diuretic therapy. However, development of diuretic resistance represents a significant problem in the management of these patients. The role of Renal Replacement Therapy (RRT) is important for patients who do not response to conservative management of fluid overload facilitating the failing heart to restore function. According to the guidelines, venovenous isolated Ultrafiltration (UF) is indicated for patients with refractory congestion not responding to medical therapy with loop diuretics and infusion of dopamine. A systematic review of randomized controlled trials on the effect of UF vs. IV furosemide for decompensated heart failure showed a benefit of UF on total body weight loss and on readmissions due to heart failure in patients with decompensated heart failure and CKD. Peritoneal dialysis (PD) can provide efficient ultrafiltration and sodium extraction in volume overloaded patients followed by decline of hospitalization days, decrease of body weight and improvement of LVEF in patients with refractory heart failure. The continuous draw of ultrafiltrate is followed by a lesser risk of abrupt hypotension and better preservation of the residual kidney function. This represents a significant advantage of PD over intermittent UF by dialysis. In conclusion, application of UF by dialysis and PD is followed by significant total body weight loss, reduced need for hospital readmissions and better quality of life. PD has a higher probability of preservation of residual kidney function and can be used by patients at home.
Topics: Heart Failure; Humans; Renal Insufficiency; Renal Replacement Therapy
PubMed: 27883326
DOI: 10.1515/prilozi-2016-0015 -
Ugeskrift For Laeger Mar 2014Rhabdomyolysis is the common denomination of conditions with destruction of skeletal muscle tissue. Complications are disturbances in the electrolyte and acid-base... (Review)
Review
Rhabdomyolysis is the common denomination of conditions with destruction of skeletal muscle tissue. Complications are disturbances in the electrolyte and acid-base balance and circulatory and renal insufficency. The pathophysiology and treatment of these systemic complications is discussed. Different recommendations exist for the prevention of renal failure; of these, only fluid therapy to restore euvolaemia has been shown to be efficient with reasonable certainty, whereas the effect of diuretic therapy, alkalinisation of the urine and haemofiltration of myoglobin remains to be proved.
Topics: Acid-Base Imbalance; Fluid Therapy; Humans; Renal Dialysis; Renal Insufficiency; Rhabdomyolysis; Water-Electrolyte Imbalance
PubMed: 25350054
DOI: No ID Found -
Lancet (London, England) May 2010Atheroembolic renal disease develops when atheromatous aortic plaques rupture, releasing cholesterol crystals into the small renal arteries. Embolisation often affects... (Review)
Review
Atheroembolic renal disease develops when atheromatous aortic plaques rupture, releasing cholesterol crystals into the small renal arteries. Embolisation often affects other organs, such as the skin, gastrointestinal system, and brain. Although the disease can develop spontaneously, it usually develops after vascular surgery, catheterisation, or anticoagulation. The systemic nature of atheroembolism makes diagnosis difficult. The classic triad of a precipitating event, acute or subacute renal failure, and skin lesions, are strongly suggestive of the disorder. Eosinophilia further supports the diagnosis, usually confirmed by biopsy of an affected organ or by the fundoscopic finding of cholesterol crystals in the retinal circulation. Renal and patient prognosis are poor. Treatment is mostly preventive, based on avoidance of further precipitating factors, and symptomatic, aimed to the optimum treatment of hypertension and cardiac and renal failure. Statins, which stabilise atherosclerotic plaques, should be offered to all patients. Steroids might have a role in acute or subacute progressive forms with systemic inflammation.
Topics: Aortic Diseases; Atherosclerosis; Coronary Angiography; Embolism, Cholesterol; Humans; Renal Insufficiency; Risk Factors
PubMed: 20381857
DOI: 10.1016/S0140-6736(09)62073-0 -
Annales de Biologie Clinique Aug 2016New highly sensitive (hs) assays have challenged the interpretation of cardiac troponins (cTn) as markers of injury while natriuretic peptides remain the markers of... (Review)
Review
New highly sensitive (hs) assays have challenged the interpretation of cardiac troponins (cTn) as markers of injury while natriuretic peptides remain the markers of choice for myocardial dysfunction. However, variability extracardiac factors such as age, gender and renal function may alter circulating levels. In chronic kidney disease (CKD), the increase in circulating levels of these biomarkers in the absence of cardiac disease underlines the problem of discriminative value for diagnosis as well as the need to redefine the thresholds. In addition, these biomarkers are of potential interest to stratify cardiovascular risk, the leading cause of death in CKD. The aim of this work is to clarify the effect of age and renal function on circulating levels of high-sensitivity troponins and natriuretic peptides.
Topics: Age Factors; Aged; Aged, 80 and over; Biomarkers; Heart; Humans; Myocardial Infarction; Myocardium; Renal Insufficiency; Troponin I; Troponin T
PubMed: 27492694
DOI: 10.1684/abc.2016.1165 -
Gaceta Medica de Mexico 2020Timely diagnosis and early therapeutic intervention reduce premature mortality associated with chronic renal failure.
INTRODUCTION
Timely diagnosis and early therapeutic intervention reduce premature mortality associated with chronic renal failure.
OBJECTIVE
To identify the prevalence and factors associated with occult renal failure in patients with chronic diseases.
METHOD
Cross-sectional study of 1268 patients with type 2 diabetes mellitus and systemic arterial hypertension. A measuring instrument with questions about associated factors such as osteoarthritis, treatment of chronic conditions, smoking, analgesic consumption, alcoholism, body mass index, physical activity and serum glucose, cholesterol and triglyceride levels was used.
RESULTS
The prevalence of occult renal failure was 13.2 % (167/1,268), 13.4 % in diabetic patients (117/876) and 14.9 % in hypertensive patients (150/1,010). In the multivariate analysis, the factors associated with occult renal failure were being older than 60 years (aOR = 1.96, 95 % CI = 1.22-2.49), belonging to the female gender (aOR = 2.17, 95 % CI = 1.30-2.82), suffering from systemic arterial hypertension (aOR = 1.96, 95% CI = 1.22-2.50) and not having overweight/obesity (aOR = 0.49, 95 % CI = 0.41-0.8).
CONCLUSIONS
The prevalence of occult renal failure was 13 %. Female patients older than 60 years with overweight/obesity and systemic arterial hypertension should be examined in detail by the family doctor for occult renal failure early detection.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Body Mass Index; Chronic Disease; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Dyslipidemias; Female; Humans; Hypertension; Male; Mexico; Middle Aged; Multivariate Analysis; Obesity; Osteoarthritis; Overweight; Prevalence; Renal Insufficiency; Sex Factors; Smoking; Young Adult
PubMed: 32026875
DOI: 10.24875/GMM.19005292 -
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 -
Transfusion Jan 2021Renal failure and renal replacement therapy (RRT) affect the immune system and could therefore modulate red blood cell (RBC) alloimmunization after transfusion.
BACKGROUND
Renal failure and renal replacement therapy (RRT) affect the immune system and could therefore modulate red blood cell (RBC) alloimmunization after transfusion.
STUDY DESIGN AND METHODS
We performed a nationwide multicenter case-control study within a source population of newly transfused patients between 2005 and 2015. Using conditional multivariate logistic regression, we compared first-time transfusion-induced RBC alloantibody formers (N = 505) with two nonalloimmunized recipients with similar transfusion burden (N = 1010).
RESULTS
Renal failure was observed in 17% of the control and 13% of the case patients. A total of 41% of the control patients and 34% of case patients underwent acute RRT. Renal failure without RRT was associated with lower alloimmunization risks after blood transfusion (moderate renal failure: adjusted relative rate [RR], 0.82 [95% confidence interval (CI), 0.67-1.01]); severe renal failure, adjusted RR, 0.76 [95% CI, 0.55-1.05]). With severe renal failure patients mainly receiving RRT, the lowest alloimmunization risk was found in particularly these patients [adjusted RR 0.48 (95% CI 0.39-0.58)]. This was similar for patients receiving RRT for acute or chronic renal failure (adjusted RR, 0.59 [95% CI, 0.46-0.75]); and adjusted RR, 0.62 [95% CI 0.45-0.88], respectively).
CONCLUSION
These findings are indicative of a weakened humoral response in acute as well as chronic renal failure, which appeared to be most pronounced when treated with RRT. Future research should focus on how renal failure and RRT mechanistically modulate RBC alloimmunization.
Topics: Aged; Blood Transfusion; Case-Control Studies; Correlation of Data; Erythrocyte Transfusion; Erythrocytes; Female; Humans; Kidney Failure, Chronic; Logistic Models; Male; Middle Aged; Renal Insufficiency; Renal Insufficiency, Chronic; Renal Replacement Therapy; Risk Factors; Transfusion Reaction
PubMed: 33295653
DOI: 10.1111/trf.16166 -
Kidney International Nov 2006Excess fatty acids accompanied by triglyceride accumulation in parenchymal cells of multiple tissues including skeletal and cardiac myocytes, hepatocytes, and pancreatic... (Review)
Review
Excess fatty acids accompanied by triglyceride accumulation in parenchymal cells of multiple tissues including skeletal and cardiac myocytes, hepatocytes, and pancreatic beta cells results in chronic cellular dysfunction and injury. The process, now termed lipotoxicity, can account for many manifestations of the 'metabolic syndrome'. Most data suggest that the triglycerides serve primarily a storage function with toxicity deriving mainly from long-chain nonesterified fatty acids (NEFA) and their products such as ceramides and diacylglycerols. In the kidney, filtered NEFA carried on albumin can aggravate the chronic tubule damage and inflammatory phenotype that develop during proteinuric states and lipid loading of both glomerular and tubular cells is a common response to renal injury that contributes to progression of nephropathy. NEFA-induced mitochondrial dysfunction is the primary mechanism for energetic failure of proximal tubules during hypoxia/reoxygenation and persistent increases of tubule cell NEFA and triglycerides occur during acute renal failure in vivo in association with downregulation of mitochondrial and peroxisomal enzymes of beta oxidation. In acute renal failure models, peroxisome proliferator-activated receptor alpha ligand treatment can ameliorate the NEFA and triglyceride accumulation and limits tissue injury likely via both direct tubule actions and anti-inflammatory effects. Both acute and chronic kidney disease are associated with systemic manifestations of the metabolic syndrome.
Topics: Animals; Fatty Acids; Humans; Kidney Tubules; Metabolic Syndrome; Renal Insufficiency
PubMed: 16955100
DOI: 10.1038/sj.ki.5001834 -
Therapeutic Apheresis and Dialysis :... Feb 2011Chronic renal failure patients receiving hemodialysis and continuous ambulatory peritoneal dialysis often encounter gastrointestinal troubles over their long treatment... (Review)
Review
Chronic renal failure patients receiving hemodialysis and continuous ambulatory peritoneal dialysis often encounter gastrointestinal troubles over their long treatment period. Helicobacter pylori infection has close association with development of peptic ulcer, gastric cancer and gastric lymphoma, and is thought to be one of the major risk factors for gastrointestinal troubles in dialysis patients. However, it is unclear whether H. pylori infection is directly associated with progression of renal dysfunction and prognosis of chronic renal failure patients. Recent consensus shows that the prevalence of H. pylori infection in chronic renal failure patients is significantly lower than in subjects with normal renal function. In the natural history of H. pylori infection in hemodialysis patients, the prevalence of infection decreases as dialysis periods progressed, in particular within the first four years after the start of treatment. However, the chance of natural eradication becomes rare for patients receiving dialysis treatment for a long time. Moreover, chronic renal failure patients with H. pylori infection have a higher incidence of gastroduodenal diseases, and therefore, are recommended to receive eradication therapies, especially for those receiving treatment for a long time and with higher risks of complication. Intensive endoscopic check-ups for the prevention of gastrointestinal events and the discovery of peptic ulcer and neoplastic diseases at an early phase may be required.
Topics: Helicobacter Infections; Helicobacter pylori; Humans; Renal Dialysis; Renal Insufficiency, Chronic
PubMed: 21272246
DOI: 10.1111/j.1744-9987.2010.00851.x -
International Journal of Molecular... Jan 2017Evidence suggests a link between opioid use and kidney disease. This review summarizes the known renal manifestations of opioid use including its role in acute and... (Review)
Review
Evidence suggests a link between opioid use and kidney disease. This review summarizes the known renal manifestations of opioid use including its role in acute and chronic kidney injury. Both the direct and indirect effects of the drug, and the context which leads to the development of renal failure, are explored. While commonly used safely for pain control and anesthesia in those with kidney disease, the concerns with respect to side effects and toxicity of opioids are addressed. This is especially relevant with the worldwide increase in the use of opioids for medical and recreational use.
Topics: Acute Kidney Injury; Analgesics, Opioid; Humans; Incidence; Kidney; Renal Insufficiency
PubMed: 28117754
DOI: 10.3390/ijms18010223