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Clinical Journal of the American... Feb 2020Hematopoietic stem cell transplantation is a life-saving therapy for many patients with cancer, as well as patients with some nonmalignant hematologic disorders, such as... (Review)
Review
Hematopoietic stem cell transplantation is a life-saving therapy for many patients with cancer, as well as patients with some nonmalignant hematologic disorders, such as aplastic anemia, sickle cell disease, and certain congenital immune deficiencies. Kidney injury directly associated with stem cell transplantation includes a wide range of structural and functional abnormalities, which may be vascular (hypertension, thrombotic microangiopathy), glomerular (albuminuria, nephrotic glomerulopathies), and/or tubulointerstitial. AKI occurs commonly after stem cell transplant, affecting 10%-73% of patients. The cause is often multifactorial and can include sepsis, nephrotoxic medications, marrow infusion syndrome, hepatic sinusoidal obstruction syndrome, thrombotic microangiopathy, infections, and graft versus host disease. The risk of post-transplant kidney injury varies depending on patient characteristics, type of transplant (allogeneic versus autologous), and choice of chemotherapeutic conditioning regimen (myeloablative versus nonmyeloablative). Importantly, AKI is associated with substantial morbidity, including the need for KRT in approximately 5% of patients and the development of CKD in up to 60% of transplant recipients. AKI has been associated universally with higher all-cause and nonrelapse mortality regardless of transplant type, and studies have consistently shown extremely high (>80%) mortality rates in those patients requiring acute dialysis. Accordingly, prevention, early recognition, and prompt treatment of kidney injury are essential to improving kidney and patient outcomes after hematopoietic stem cell transplantation, and for realizing the full potential of this therapy.
Topics: Acute Kidney Injury; Early Diagnosis; Hematopoietic Stem Cell Transplantation; Humans; Incidence; Renal Insufficiency, Chronic; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 31836598
DOI: 10.2215/CJN.08580719 -
Kidney International Sep 2021Kidney disease is an important public health problem. Both acute kidney injury (AKI) and chronic kidney disease have been well defined and classified, leading to...
Kidney disease is an important public health problem. Both acute kidney injury (AKI) and chronic kidney disease have been well defined and classified, leading to improved research efforts and subsequent management strategies and recommendations. For those patients with abnormalities in kidney function and/or structure who meet neither the definition of AKI nor chronic kidney disease, there remains a gap in research, care, and guidance. The term acute kidney diseases and disorders, abbreviated to acute kidney disease (AKD), has been introduced as an important construct to address this. To expand and harmonize existing definitions and to ultimately better inform research and clinical care, Kidney Disease: Improving Global Outcomes (KDIGO) organized a consensus workshop. Multiple invitees from around the globe, representing both acute and chronic kidney disease researchers and experts, met virtually to examine existing data, and discuss key concepts related to AKD. Despite some remaining unresolved questions, conference attendees reached general consensus on the definition and classification of AKD, management strategies, and research priorities. AKD is defined by abnormalities of kidney function and/or structure with implications for health and with a duration of ≤3 months. AKD may include AKI, but, more importantly, also includes abnormalities in kidney function that are not as severe as AKI or that develop over a period of >7 days. The cause(s) of AKD should be sought, and classification includes functional and structural parameters. Management of AKD is currently based on empirical considerations. A robust research agenda to enable refinement and validation of definitions and classification systems, and thus testing of interventions and strategies, is proposed.
Topics: Acute Disease; Acute Kidney Injury; Consensus; Humans; Kidney; Renal Insufficiency, Chronic
PubMed: 34252450
DOI: 10.1016/j.kint.2021.06.028 -
Kidney & Blood Pressure Research 2021Chronic kidney disease-associated pruritus (CKD-aP), also known as uraemic pruritus, is a disabling symptom for patients and a challenging condition for clinicians.... (Review)
Review
BACKGROUND
Chronic kidney disease-associated pruritus (CKD-aP), also known as uraemic pruritus, is a disabling symptom for patients and a challenging condition for clinicians. Despite being common amongst end-stage kidney disease (ESKD) patients, it remains underestimated and underdiagnosed. The exact pathogenesis remains largely elusive, which hampers the synthesis of a definite treatment approach.
SUMMARY
Chronic pruritus (lasting 6 weeks or more in duration) is a common and potentially disabling symptom in patients with advanced CKD. A unified hypothesis of pathogenesis has not yet been concluded. Studies have shown changes in the immunochemical milieu of the skin in patients with CKD-aP with several inciting stimuli identified. However, other unrecognized factors are likely to be involved. This article will review the current observations and understanding of the postulated pathogenesis of CKD-aP, as well as the evidence for current management strategies. Key Messages: CKD-aP is a common and troubling symptom amongst ESKD patients that is associated with decreased quality of life and poor prognosis. Its exact pathogenesis, at the time of writing, is not well-understood. A stepwise approach is recommended for management. Systematic reviews show the largest body of evidence was found for the effectiveness of gabapentin. Comparison is needed between newly emerging pharmacological agents such as kappa-opioid receptor agonists and more established agents, such as the gabapentinoids. Finally, renal transplantation should be considered in severe and refractory cases who are suitable transplant candidates as it has shown an excellent outcome in most cases.
Topics: Disease Management; Disease Progression; Humans; Kidney Failure, Chronic; Pruritus; Quality of Life; Renal Insufficiency, Chronic
PubMed: 34515143
DOI: 10.1159/000518391 -
Cells Nov 2022Acute kidney injury (AKI) is a major clinical problem associated with increased morbidity and mortality. Despite intensive research, the clinical outcome remains poor,... (Review)
Review
Acute kidney injury (AKI) is a major clinical problem associated with increased morbidity and mortality. Despite intensive research, the clinical outcome remains poor, and apart from supportive therapy, no other specific therapy exists. Furthermore, acute kidney injury increases the risk of developing chronic kidney disease (CKD) and end-stage renal disease. Acute tubular injury accounts for the most common intrinsic cause of AKI. The main site of injury is the proximal tubule due to its high workload and energy demand. Upon injury, an intratubular subpopulation of proximal epithelial cells proliferates and restores the tubular integrity. Nevertheless, despite its strong regenerative capacity, the kidney does not always achieve its former integrity and function and incomplete recovery leads to persistent and progressive CKD. Clinical and experimental data demonstrate sexual differences in renal anatomy, physiology, and susceptibility to renal diseases including but not limited to ischemia-reperfusion injury. Some data suggest the protective role of female sex hormones, whereas others highlight the detrimental effect of male hormones in renal ischemia-reperfusion injury. Although the important role of sex hormones is evident, the exact underlying mechanisms remain to be elucidated. This review focuses on collecting the current knowledge about sexual dimorphism in renal injury and opportunities for therapeutic manipulation, with a focus on resident renal progenitor stem cells as potential novel therapeutic strategies.
Topics: Male; Female; Humans; Acute Kidney Injury; Kidney; Renal Insufficiency, Chronic; Reperfusion Injury; Gonadal Steroid Hormones
PubMed: 36497080
DOI: 10.3390/cells11233820 -
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 -
Lakartidningen Mar 2023Hyperkalemia is a relatively common electrolyte abnormality that in serious cases can lead to life-threatening arrhythmias. There are a number of factors that can...
Hyperkalemia is a relatively common electrolyte abnormality that in serious cases can lead to life-threatening arrhythmias. There are a number of factors that can contribute to hyperkalemia, and in most cases some level of kidney failure is present. The management of hyperkalemia depends on the underlying cause and the level of potassium. This paper briefly examines the pathophysiological mechanisms behind hyperkalemia, with a special focus on treatment.
Topics: Humans; Hyperkalemia; Potassium; Renal Insufficiency; Arrhythmias, Cardiac
PubMed: 36912790
DOI: No ID Found -
Endocrinology and Metabolism (Seoul,... Apr 2022
Topics: Female; Humans; Hyperthyroidism; Male; Renal Insufficiency
PubMed: 35504599
DOI: 10.3803/EnM.2022.201 -
Missouri Medicine 2011In today's clinical practice, a physician takes care of increasing number of patients with both cardiac and renal dysfunction. Due to our increased understanding of... (Review)
Review
In today's clinical practice, a physician takes care of increasing number of patients with both cardiac and renal dysfunction. Due to our increased understanding of pathogenesis of cardiac dysfunction in patients with renal failure and vice versa, the definition of Cardio-Renal Syndrome has undergone a change. This article discusses briefly the types and pathogenesis of the Cardio-Renal Syndromes.
Topics: Heart Failure; Humans; Renal Insufficiency; Syndrome
PubMed: 21462610
DOI: No ID Found -
Kidney International Sep 2008Renal aging, by itself, is associated with alterations in renal morphology and a decline in renal function, which is accelerated and/or accentuated by diseases such as... (Review)
Review
Renal aging, by itself, is associated with alterations in renal morphology and a decline in renal function, which is accelerated and/or accentuated by diseases such as diabetes mellitus and hypertension. The aging-related renal insufficiency has important implications with regards to body homeostasis, drug toxicity, and renal transplantation. An understanding of renal aging and its distinction from renal insufficiency secondary to diseases is essential for individualized care of the elderly. Toward this end, investigations are underway to elucidate the molecular mechanisms of renal aging. This review summarizes the structural and functional changes of the aging kidney and highlights the advances made in our understanding of the renal aging process.
Topics: Aged; Aging; Humans; Kidney; Kidney Transplantation; Oxidative Stress; Renal Insufficiency
PubMed: 18614996
DOI: 10.1038/ki.2008.319 -
Polish Archives of Internal Medicine Sep 2018
Topics: Animals; Chickens; Follow-Up Studies; Renal Insufficiency; Renal Insufficiency, Chronic; Takotsubo Cardiomyopathy
PubMed: 30265257
DOI: 10.20452/pamw.4339