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Current Opinion in Cardiology May 2016The purpose of this review is to describe the effects of mechanical circulatory support (MCS) on changes in kidney function and their relationship with mortality, with... (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to describe the effects of mechanical circulatory support (MCS) on changes in kidney function and their relationship with mortality, with an additional focus on the evaluation and management of both preimplant and post-MCS renal dysfunction.
RECENT FINDINGS
Renal dysfunction is highly prevalent in patients referred for MCS and is associated with significantly increased mortality and postoperative acute kidney injury. Most patients, including those with renal dysfunction, experience marked early improvement in renal function with MCS, likely secondary to correction of the cardiogenic shock, volume overload, and neurohormonal activation characteristic of advanced heart failure. Currently, there are no diagnostic tests to definitively distinguish reversible forms of renal dysfunction likely to improve with MCS from irreversible renal dysfunction. Furthermore, the characteristic improvements in renal function observed in the early months of MCS are often transient, with subsequent recurrence of renal dysfunction with longer durations of support. Venous congestion, right ventricular dysfunction, and reduced pulsatility are potential mechanisms involved in resurgence of renal dysfunction following MCS.
SUMMARY
With the exponential growth of MCS, research endeavors to both improve understanding of the mechanisms behind observed changes in renal function and elucidate the device-related effects on the kidney are imperative.
Topics: Assisted Circulation; Heart Failure; Humans; Patient Selection; Prognosis; Renal Dialysis; Renal Insufficiency
PubMed: 27022890
DOI: 10.1097/HCO.0000000000000278 -
World Journal of Gastroenterology Mar 2021Chronic kidney disease (CKD) in patients with liver cirrhosis has become a new frontier in hepatology. In recent years, a sharp increase in the diagnosis of CKD has been...
Chronic kidney disease (CKD) in patients with liver cirrhosis has become a new frontier in hepatology. In recent years, a sharp increase in the diagnosis of CKD has been observed among patients with cirrhosis. The rising prevalence of risk factors, such as diabetes, hypertension and nonalcoholic fatty liver disease, appears to have contributed significantly to the high prevalence of CKD. Moreover, the diagnosis of CKD in cirrhosis is now based on a reduction in the estimated glomerular filtration rate of < 60 mL/min over more than 3 mo. This definition has resulted in a better differentiation of CKD from acute kidney injury (AKI), leading to its greater recognition. It has also been noted that a significant proportion of AKI transforms into CKD in patients with decompensated cirrhosis. CKD in cirrhosis can be structural CKD due to kidney injury or functional CKD secondary to circulatory and neurohormonal imbalances. The available literature on combined cirrhosis-CKD is extremely limited, as most attempts to assess renal dysfunction in cirrhosis have so far concentrated on AKI. Due to problems related to glomerular filtration rate estimation in cirrhosis, the absence of reliable biomarkers of CKD and technical difficulties in performing renal biopsy in advanced cirrhosis, CKD in cirrhosis can present many challenges for clinicians. With combined hepatorenal dysfunctions, fluid mobilization becomes problematic, and there may be difficulties with drug tolerance, hemodialysis and decision-making regarding the need for liver simultaneous liver and kidney transplantation. This paper offers a thorough overview of the increasingly known CKD in patients with cirrhosis, with clinical consequences and difficulties occurring in the diagnosis and treatment of such patients.
Topics: Acute Kidney Injury; Gastroenterology; Glomerular Filtration Rate; Humans; Liver Cirrhosis; Renal Insufficiency, Chronic
PubMed: 33776368
DOI: 10.3748/wjg.v27.i11.990 -
Clinical Journal of the American... May 2020
Topics: Angiotensin-Converting Enzyme Inhibitors; Child; Humans; Renal Insufficiency, Chronic; Renin-Angiotensin System
PubMed: 32253276
DOI: 10.2215/CJN.02920320 -
British Medical Journal Jun 1952
Topics: Humans; Kidney Diseases; Renal Insufficiency
PubMed: 14935280
DOI: No ID Found -
Canadian Medical Association Journal Oct 1956
Topics: Humans; Kidney Diseases; Renal Insufficiency
PubMed: 13364815
DOI: No ID Found -
Kidney International. Supplement Dec 1998Data provided by end-stage renal disease (ESRD) registries document a progressive and striking increase in the incidence of hypertension-related ESRD over the years, and... (Review)
Review
Data provided by end-stage renal disease (ESRD) registries document a progressive and striking increase in the incidence of hypertension-related ESRD over the years, and its prevalence supports the classic statement that the kidney may be a victim of hypertension. Two clinical conditions should be considered separately when the role of hypertension in progressive renal disease is discussed: (a) hypertension and primary renal disease and (b) progressive renal disease in essential hypertension. The appearance of systemic hypertension is one of the major risk factors for the progressive deterioration of primary renal disease both in experimental models and in humans. Strict blood pressure control is able to significantly reduce the disease progression to renal failure. Angiotensin-converting enzyme inhibitors probably show a better nephroprotective action than other antihypertensive agents. Long-lasting hypertension may induce ESRD in some patients through hypertensive nephrosclerosis. In many cases of progressive renal disease associated with essential hypertension, particularly in elderly Caucasians, atheromatous renovascular disease via renal artery stenosis and/or cholesterol microembolization represent the main cause of ESRD.
Topics: Disease Progression; Humans; Nephrosclerosis; Renal Insufficiency
PubMed: 9839285
DOI: 10.1046/j.1523-1755.1998.06814.x -
Blood Purification 2019Renal failure patients have an increased risk of infection, including skin and soft tissue infections. This increased susceptibility is multifactorial, due to the... (Review)
Review
Renal failure patients have an increased risk of infection, including skin and soft tissue infections. This increased susceptibility is multifactorial, due to the conditions causing the renal failure as well as complications of treatment and renal failure's innate effects on patient health. These infections have a significant impact on patient morbidity, increased hospital and procedural demands, and the cost of health care. Many renal failure patients are seen regularly by their nephrology clinic caregivers due to the need for frequent dialysis and transplant monitoring. Familiarity with common skin and soft tissue infections by these caregivers allowing enhanced patient education, optimal infection prevention, and early recognition could significantly reduce the morbidity and cost of these disorders, such as diabetic foot syndrome, necrotizing fasciitis, and herpetic infections.
Topics: Costs and Cost Analysis; Diabetic Foot; Fasciitis, Necrotizing; Herpes Simplex; Humans; Patient Education as Topic; Renal Insufficiency; Risk Factors
PubMed: 30517912
DOI: 10.1159/000494594 -
Clinical Lymphoma, Myeloma & Leukemia Dec 2016Free light chain (FLC) assays are essential for diagnosis and follow-up of plasma cell dyscrasia. Two assays are available: Freelite (Binding Site) and N Latex FLC...
BACKGROUND
Free light chain (FLC) assays are essential for diagnosis and follow-up of plasma cell dyscrasia. Two assays are available: Freelite (Binding Site) and N Latex FLC (Siemens). The aim of our study was to evaluate the impact of renal failure on concordance and correlation between the 2 FLC assays.
METHODS
FLC measurements using both assays were performed on 1215 fresh serum samples from patients with or without monoclonal gammopathy and renal failure. Concordance and correlation were evaluated using Passing-Bablock regression, Pearson correlation coefficient, and the Cohen kappa coefficient, taking into account the renal failure stage (evaluated with Chronic Kidney Disease-Epidemiology Collaboration formulae) and evaluation of treatment response in patients' follow-up.
RESULTS
A good correlation was demonstrated between both assays, irrespective of the renal failure stage (Pearson correlation coefficient > 0.90). For FLC ratio interpretation, there remained 7.6% to 20.8% discordances between the 2 methods throughout the whole range of renal impairment. To evaluate FLC evolution in patient follow-up, 41 patients were selected with at least 6 consecutive serum samples being collected during the study period: we observed a concordant evolution of FLC concentrations between both assays. However, few discrepancies were observed with 4 patients.
CONCLUSIONS
Despite adjusted reference ranges for Freelite FLC ratio, there are approximately 12.5% discrepancies in interpretation of FLC ratio between the 2 available assays. They are not linked to renal failure stage and neither of the assays performed better than the other: results must be interpreted taking into account clinical data and the same assay must be used for patient follow-up.
Topics: Biomarkers; Follow-Up Studies; Humans; Immunoglobulin G; Immunoglobulin Light Chains; Immunoglobulin kappa-Chains; Immunoglobulin lambda-Chains; Kidney Function Tests; Paraproteinemias; Renal Insufficiency; Renal Insufficiency, Chronic; Reproducibility of Results
PubMed: 27618362
DOI: 10.1016/j.clml.2016.08.012 -
International Journal of Environmental... Sep 2022The existing trials have focused on a variety of interventions to improve outcomes in renal failure; however, quantitative evidence comparing the effect of performing... (Meta-Analysis)
Meta-Analysis Review
The existing trials have focused on a variety of interventions to improve outcomes in renal failure; however, quantitative evidence comparing the effect of performing multidimensional interventions is scarce. The present paper reviews data from previous randomized controlled trials (RCTs), examining interventions performed for patients with chronic kidney disease (CKD) and transplants by multidisciplinary teams, including pharmacists. Methods: A systematic search with quality assessment was performed using the revised Cochrane Collaboration's 'Risk of Bias' tool. Results and Conclusion: Thirty-three RCTs were included in the review, and the data from nineteen protocols were included in further quantitative analyses. A wide range of outcomes was considered, including those associated with progression of CKD, cardiovascular risk factors, patient adherence, quality of life, prescription of relevant medications, drug-related problems (DRPs), rate of hospitalizations, and death. The heterogeneity between studies was high. Despite low-to-moderate quality of evidence and relatively short follow-up, the findings suggest that multidimensional interventions, taken by pharmacists within multidisciplinary teams, are important for improving some clinical outcomes, such as blood pressure, risk of cardiovascular diseases and renal progression, and they improve non-adherence to medication among individuals with renal failure.
Topics: Hospitalization; Humans; Pharmacists; Quality of Life; Renal Insufficiency; Renal Insufficiency, Chronic
PubMed: 36141441
DOI: 10.3390/ijerph191811170 -
Missouri Medicine 2011The kidneys perform a wide array of functions in the body, most of which are essential for life. Regulation of water and electrolytes, excretion of metabolic waste and... (Review)
Review
The kidneys perform a wide array of functions in the body, most of which are essential for life. Regulation of water and electrolytes, excretion of metabolic waste and of bioactive substances like hormones, drugs etc., which affect bodily functions; regulation of arterial blood pressure, red blood cell and vitamin D production; are some of the major functions that the kidneys perform. It is obvious then, that patients with renal failure present a steep challenge to the physician taking care of this special population. Renal replacement therapy remains only a part of treatment that helps substitute the regulation of water and electrolytes, removal of metabolic waste, and to a certain extent removal of drugs and other bioactive substances from the body. This article aims to provide an understanding of different types of renal replacement therapy, mainly to patients with end-stage renal disease (ESRD).
Topics: Humans; Nephrology; Renal Insufficiency; Renal Replacement Therapy
PubMed: 21462611
DOI: No ID Found