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RenalInsufficiency

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DNA abnormalities found in children with chronic kidney disease

Routine genetic screening of children with CKD could lead to earlier, more precise diagnosesA significant proportion of children with chronic kidney disease (CKD) have...  
medicalnewstoday.com
over 4 years ago
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A risk score for chronic kidney disease can inform choice of HIV medications

Both traditional and HIV-related risk factors can predict the likelihood of developing chronic kidney disease (CKD), according to a study published in PLOS Medicine.  
medicalnewstoday.com
over 4 years ago
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Study uncovers predictors of chronic kidney disease worsening in children and adolescents

Modifiable risk factors for kidney failure lay foundation for intervention and improved outcomesStudy results published in the National Kidney Foundation's American...  
medicalnewstoday.com
over 4 years ago
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'Preventable acute kidney injury deaths could end by 2025'

Experts call for an end to preventable acute kidney injury deaths within the next 10 years, while another study suggests that kidney failure is being undertreated worldwide.  
medicalnewstoday.com
over 4 years ago
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Does IV contrast cause renal failure? - emdocs

Latest evidence and recommendations for how to proceed in the ED  
emdocs.net
over 4 years ago
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Acute Liver Failure: Treatment (Part 2 of 2)

Management of acute liver failure is largely supportive critical care for the multiorgan failure that frequently results. Severe acute liver failure results in rapidly progressive hepatic encephalopathy and lethal cerebral edema; this complication requires special vigilance and expert management. Hypoglycemia, hyponatremia, and metabolic disturbances from renal failure may also require continual attention. Whenever possible, transfer to a liver transplant center should be considered for any patient with severe acute liver failure. If this is not possible, local or remote consultation of a liver transplant physician (hepatologist and/or transplant surgeon) should be sought, as well as a neurologist.  
pulmccm.org
over 4 years ago
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Episode 21 – Acute Kidney Injury

(ITUNES OR LISTEN HERE) The Free Open Access Medical Education (FOAM) Dr. Josh Farkas of the PulmCrit blog has produced a couple of blog posts on the importance of renal protection in sepsis, Renoresuscitation: Sepsis resuscitation designed to avoid long-term complications and Renal microvascular hemodynamics in sepsis: a new paradigm.  Much of this is theoretical and certainly not…  
foamcast.org
over 4 years ago
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Is correcting hyperchloremic acidosis beneficial?

  0 Clinical Question 0 An elderly woman presents with renal failure due to severe dehydration from diarrhea.  She has a hyperchloremic acidosis from diarr  
pulmcrit.org
over 4 years ago
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Critical Care

The Surviving Sepsis Campaign [1] advocates maintaining a mean arterial pressure (MAP) of at least 65 mm Hg in sepsis patients undergoing resuscitation. Leone and colleagues [2], in an article published in this journal, suggest considering higher MAP targets in the resuscitation of patients with a history of arterial hypertension so they do not progress to acute kidney injury. Asfar and colleagues [3], in a multicenter, open-label trial, showed no significant difference in mortality outcomes in septic shock patients undergoing resuscitation with an MAP target of either 80 to 85 mm Hg (high-target group) or 65 to 70 mm Hg (low-target group). However, the study did show that chronic hypertensive patients in the higher-target group had lower incidences of acute kidney injury and renal replacement therapy. This likely stems from the need for higher MAPs in chronic hypertensive patients in order to maintain organ blood flow because of a shift of the organ’s autoregulatory range to the right. Thus, targeting a higher MAP for chronic hypertensive patients may help avoid the development of acute kidney injury and the need for renal replacement therapy. Renal replacement therapy carries with it inherent morbidity as well as additional cost. These costs include the need for dialysate fluid and extra personnel and the use of anticoagulation and the extracorporeal circuit [2]. However, chronic hypertensive patients in the high-target group had a greater incidence of new-onset atrial fibrillation (5.2% in the low-target group versus 9% in the high-target group). Patients with new-onset atrial fibrillation during sepsis have been shown to have increased incidences of in-hospital stroke and in-hospital mortality [4] as well as subsequent recurrence of atrial fibrillation and increased long-term risks for heart failure, ischemic stroke, and death [5]. This may offset any benefit of a higher MAP. The ideal target MAP may have to be individualized for specific patient populations. More studies are needed to determine whether baseline blood pressure plays a role in the ultimate determination of the ideal MAP target for patients with sepsis.  
ccforum.com
over 4 years ago
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Acute Kidney Injury: Pearls and Pitfalls - emdocs

Learn the latest tips and resources when dealing with acute kidney injury (AKI) via the KDIGO group. Enjoy!  
emdocs.net
over 4 years ago
Www.bmj
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Management of anaemia in chronic kidney disease: summary of updated NICE guidance

Various factors—including deficiency of erythropoietin, iron, folate, or vitamin B12; blood loss; infection; and inflammation—contribute to the development of the anaemia of chronic kidney disease  
feeds.bmj.com
over 4 years ago
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Immunosuppressive agents for treating IgA nephropathy | Cochrane

IgA nephropathy is a common kidney disease that often leads to decreased kidney function and may result ultimately in kidney failure for one-third of affected people. The cause of IgA nephropathy is not known, although most people with the disease have abnormalities in their immune system. We identified 32 studies enrolling 1781 patients that met our inclusion criteria. This review found that if people with IgA nephropathy receive immunosuppressive drugs, particularly steroids, they may be less likely to develop kidney failure needing dialysis or transplantation. Few studies were available and the harms of therapy are currently not well understood. Larger placebo-controlled studies are now needed to be certain about the benefits and hazards of steroids on outcomes in IgA nephropathy and to identify which specific patients might benefit most from the treatment.  
cochrane.org
about 4 years ago
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Interventions for preventing and treating kidney disease in Henoch-Schönlein Purpura | Cochrane

Henoch-Schönlein Purpura (HSP) causes inflammation of small blood vessels in children and affects approximately 20/100,000 children annually. Symptoms and signs include a purpuric skin rash (which comprises small spots and larger bruises), abdominal pain, gastrointestinal bleeding, joint pain and swelling, facial swelling and evidence of kidney disease with blood and protein in the urine. Kidney disease occurs in about one third of children with HSP. In the majority this is mild (small amounts of blood in the urine only) and resolves completely but a few children have persistent kidney disease that can progress to kidney failure.  
cochrane.org
about 4 years ago
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Clinical Cases and Images: ClinicalCases.org: Prerenal Acute Renal Failure due to Volume Depletion

This is a good practical case and very useful for new clinicians. For any clinician:No foley catheter unless oliguric, anuric, obstructed since any catheter is a foreign body and increases infection risk.Rehydrate if U/A has high spec gavity, mucous membranes dry, or if BUN is >30 times the creatinine as in this case. Even CHF pts get dry if not in heart failure. If in doubt, do CXR, BNPT, listen for crackles.Start with 250cc IVF if BNPT not less than 150 or give carefully while checking lung bases posteriorly after each bolus along with pulse ox, etc as above. Half of pts in acute renal failure are septic. Look for and eliminate source such as pneumonia, foreign body, pyelonephritis, joint infections. May be afebrile/ low temp or low WBCs with sepsis. Do cultures, check lactate ASAP to detect sepsis BEFORE the BP drops. Lactic acid "the troponin of sepsis." If septic, give a lot of fluids (up to 10 liters often) since capillary leak syndrome will lead to severe hypotension. If septic expect edema to develop with IV boluses yet be aware pt is intravascularly depleted. No pressors without fluids "pressors are not your friend" as per lecturers on Surviving Sepsis campaign.  
clinicalcases.org
about 4 years ago
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Prerenal Acute Renal Failure with High FENa (Fractional Excretion of Sodium)

Very good case in showing a frequently overlooked issue of diuretics. Remember, there is almost never a reason to give both fluids and diuretics...make up your mind. IV fluids are the #1 method to try in oliguric pts NOT Lasix.Do not agree with Foley cath placement if patient is able to urinate and can check creatinine to know pt is improving. Any catheter is a foreign body and increases infection risk.It is also very uncomfortable for patients.Not sure why U/S of kidney needed right away either unless the patient has chronic kidney disease or does not improve with fluids.Unnecessary tests add to the expense of healthcare which all of us pay for. This increases insurance costs, medicaid costs, etc so much it can put companies (and gov't in the future?) out of business.  
clinicalcases.org
about 4 years ago
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Clinical Cases and Images: Nonsteroidal Antiinflammatory Drugs (NSAIDs)-Induced Acute Renal Failure

Renal failure with nsaids is an entity which is rarely seen these days, partly due to more awareness of the side effects of these drugs and partly because of the emergence of novel, safe painkillers. acute renal failure caused by NSAIDS is rarer still and one should be cautious while making this diagnosis. a lot of other agents and simultaneous medications which the patient is taking is usually the cause.  
clinicalcases.org
about 4 years ago
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Chronic kidney disease from a patient perspective

The symptoms of kidney disease don’t show up until you’ve lost most of your kidney function.  
kevinmd.com
about 4 years ago
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Incidences and clinical outcomes of acute kidney injury in ICU: a prospective observational study in Sri Lanka

Acute kidney injury (AKI) is a common and a serious complication among patients admitted to intensive care units (ICUs), and has been the focus of many studies leading to recent advances in diagnosis and classification. The incidence and outcome of AKI in Sri Lankan ICUs is largely unknown. The aim of this study was to describe the incidence, severity and outcome of AKI among patients admitted to the medical ICU, National Hospital, Colombo, Sri Lanka (NHSL).  
biomedcentral.com
about 4 years ago
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Incidence and Outcomes in Acute Kidney Injury: A Comprehensive Population-Based Study

Epidemiological studies of acute kidney injury (AKI) and acute-on-chronic renal failure (ACRF) are surprisingly sparse and confounded by differences in definition. Reported incidences vary, with few studies being population-based. Given this and our aging population, the incidence of AKI may be much higher than currently thought. We tested the hypothesis that the incidence is higher by including all patients with AKI (in a geographical population base of 523,390) regardless of whether they required renal replacement therapy irrespective of the hospital setting in which they were treated. We also tested the hypothesis that the Risk, Injury, Failure, Loss, and End-Stage Kidney (RIFLE) classification predicts outcomes. We identified all patients with serum creatinine concentrations ≥150 μmol/L (male) or ≥130μmol/L (female) over a 6-mo period in 2003. Clinical outcomes were obtained from each patient's case records. The incidences of AKI and ACRF were 1811 and 336 per million population, respectively. Median age was 76 yr for AKI and 80.5 yr for ACRF. Sepsis was a precipitating factor in 47% of patients. The RIFLE classification was useful for predicting full recovery of renal function (P < 0.001), renal replacement therapy requirement (P < 0.001), length of hospital stay [excluding those who died during admission (P < 0.001)], and in-hospital mortality (P = 0.035). RIFLE did not predict mortality at 90 d or 6 mo. Thus the incidence of AKI is much higher than previously thought, with implications for service planning and providing information to colleagues about methods to prevent deterioration of renal function. The RIFLE classification is useful for identifying patients at greatest risk of adverse short-term outcomes.  
jasn.asnjournals.org
about 4 years ago