RESUMO
Slow low efficiency dialysis (SLED) is a hybrid technique of renal replacement therapy. It can be performed with a mobile single-pass batch dialysis system (Genius®) or the multifunctional hemodialysis machines, with reduced dialysate flow and the extended duration of the procedure. The present article reviews the recently published data comparing SLED to continuous renal replacement modalities in critically ill patients with acute kidney injury (AKI). The technical aspects as well as the practical advantages of SLED-Genius®are discussed, and our experience of using SLED for intraoperative renal replacement therapy during liver transplantation is shortly presented.
Assuntos
Injúria Renal Aguda , Diálise Renal , Terapia de Substituição Renal , Estado Terminal , HumanosRESUMO
INTRODUCTION: Dialysis-dependent (DD) multiple myeloma patients (MM) have a poor prognosis and high tumour burden, thus may benefit from autologous peripheral blood stem cell transplantation (auto-PBSCT), however, these patients have an increased risk of toxicity. AIMS: To evaluate the outcomes (toxicity, PFS, OS) of high dose therapy followed by auto-PBSCT during an observational study and after propensity score matching. PATIENTS AND METHODS: Between 2004-2015, 24 DD patients, (aged 38-67 years), ISS 3, treated with auto-PBSCT, requiring dialysis at diagnosis and auto-PBSCT were evaluated, matched and compared to 55 normal renal function MM patients (NRF) with ISS 3 for outcomes of interest. RESULTS: In DD patients compared to NRF patients risk of mucositis (88% vs 55%), infection (79% vs 51%), parenteral nutrition (50% vs 24%), diarrhoea (71% vs 38%), prolonged duration of hospitalisation (medians: 30 vs 21 days), requirement for RBC transfusion (83% vs 36%) were significantly higher, while no significant differences were found in post-transplant response (ORR; 75% vs 87%), 5-year PFS (36% vs 20%) and OS (39% vs 50%). Subgroup analyses based on toxicity supported these results. CONCLUSIONS: Despite the increased risk of toxicity in DD patients these events do not significantly affect both the PFS and OS.
Assuntos
Mieloma Múltiplo/terapia , Transplante de Células-Tronco de Sangue Periférico , Diálise Renal , Adulto , Idoso , Biomarcadores , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/complicações , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/mortalidade , Estadiamento de Neoplasias , Transplante de Células-Tronco de Sangue Periférico/efeitos adversos , Transplante de Células-Tronco de Sangue Periférico/métodos , Polônia , Insuficiência Renal/complicações , Insuficiência Renal/terapia , Transplante AutólogoRESUMO
Hyperphosphatemia is a common finding in advanced chronic kidney disease (CKD) and is associated with increased morbidity and mortality. Optimal phosphate control in dialysis patients is a real challenge. In the article, the authors discuss the main phosphate-lowering approaches, such as a change of dietary habits with phosphate restriction and pharmacologic treatment. Several old and new currently available oral phosphate binders are reviewed with their advantages and disadvantages.
Assuntos
Hiperfosfatemia/tratamento farmacológico , Hiperfosfatemia/metabolismo , Fosfatos/metabolismo , Insuficiência Renal Crônica/tratamento farmacológico , Insuficiência Renal Crônica/metabolismo , Combinação de Medicamentos , Compostos Férricos/uso terapêutico , Humanos , Hiperfosfatemia/complicações , Insuficiência Renal Crônica/complicações , Sevelamer/uso terapêuticoRESUMO
Recurrent urinary tract infections (rUTI), defined as ≥3 UTI/year or ≥2 UTI/half year, are among the most frequent bacterial infections in women and pose a significant clinical challenge to general practitioner. The main risk factors are: sexual activity with different partners, and - in postmenopausal women - urinary incontinence or incomplete voiding. In the article the current treatment and prevention strategies for rUTI are discussed.
Assuntos
Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/prevenção & controle , Adjuvantes Imunológicos/uso terapêutico , Anti-Infecciosos/uso terapêutico , Antibioticoprofilaxia/estatística & dados numéricos , Feminino , Humanos , Probióticos/uso terapêutico , Prevenção Secundária/métodosRESUMO
Urolithiasis is a common condition linked to lifestyle factors and its prevalence is increasing in Europe and United States. Nevertheless, recurrence of urinary stones can be effectively prevented by dietary and life style changes. The review focuses on general dietary recommendations as well as specific medical therapy for kidney stone formers.
Assuntos
Dieta/normas , Urolitíase/dietoterapia , Urolitíase/tratamento farmacológico , Europa (Continente) , Feminino , Humanos , Estilo de Vida , Masculino , Fatores de Risco , Urolitíase/diagnósticoRESUMO
Renal cell carcinoma accounts for about 3-4% of all malignancies and its incidence is steadily rising. The article presents in short the rationale behind the targeted therapies and provides an update on current therapeutic approaches to metastatic renal cell carcinoma. It also summarizes the most recent developments in the immunotherapy such as immune checkpoint inhibitors, anti-cancer vaccines and chimeric antigen receptors on T cells.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Vacinas Anticâncer/uso terapêutico , Carcinoma de Células Renais/terapia , Imunoterapia , Terapia de Alvo Molecular , HumanosRESUMO
Malignancies may be associated with a variety of renal complications. These include: acute kidney injury, chronic tubulointerstitial and vascular pathologies as well as paraneoplastic glomerulonephritis. Membranous nephropathy consists a main paraneoplastic glomerulopathy in solid tumors, and minimal change disease is the most common in haematologic malignancies, especially in Hodgkin lymphoma. Epidemiology, pathogenesis, clinical manifestations and management of these conditions are described in the paper.
Assuntos
Injúria Renal Aguda/epidemiologia , Neoplasias Hematológicas/epidemiologia , Síndromes Paraneoplásicas/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Injúria Renal Aguda/terapia , Glomerulonefrite/epidemiologia , Neoplasias Hematológicas/terapia , Humanos , Síndromes Paraneoplásicas/terapia , Insuficiência Renal Crônica/terapia , Fatores de RiscoRESUMO
Monoclonal gammopathies are a group of diseases caused by proliferation of a single clone of plasmocytes - or lymphoplasmacytic cells producing a monoclonal protein. Renal failure occurs in 20-50% of the patients with multiple myeloma, with myeloma cast nephropathy being its major cause. The other mechanisms of kidney injury include hypercalcemia, AL amyloidosis, light chain deposition disease and others. Patients who develop renal impairment have worse survival than those with normal kidney function. This article discusses the pathogenesis, evaluation and therapy of the renal diseases due to monoclonal gammopathies.
Assuntos
Paraproteinemias/epidemiologia , Insuficiência Renal/epidemiologia , Glomerulonefrite/epidemiologia , Humanos , Rim/patologia , Diálise RenalRESUMO
Infections cause approximately 1/3 of acute kidney injury (AKI) cases and a substantial number of chronic and end-stage renal failure. Renal disease may also be a side effect of antimicrobial agents. In turn, people suffering from kidney diseases, especially requiring renal replacement therapy are predisposed to severe infections often of atypical clinical course.
Assuntos
Injúria Renal Aguda/terapia , Doenças Transmissíveis/complicações , Falência Renal Crônica/terapia , Injúria Renal Aguda/etiologia , Humanos , Falência Renal Crônica/etiologia , Fatores de Risco , Medicina TropicalRESUMO
Acute kidney injury (AKI) is a common complication in liver transplant recipients. Affecting ~25% of patients preoperatively, and up to 60% postoperatively significantly worsens the prognosis. Etiology differs depending on the time of its onset, from mostly prerenal before the transplantation, ischemic in the early postoperative period to toxic AKI later on. Liver transplantation is a lenghty and complex procedure with a significant risk of hemodynamic instability, metabolic acidosis and electrolyte disturbances. The article discusses the risk of AKI development in patients undergoing liver transplanation and the indications to renal replacement therapy in the perioperative period.
Assuntos
Injúria Renal Aguda/etiologia , Injúria Renal Aguda/prevenção & controle , Transplante de Fígado/efeitos adversos , Injúria Renal Aguda/diagnóstico , Humanos , Transplante de Fígado/estatística & dados numéricos , Cuidados Pré-Operatórios/métodos , Terapia de Substituição Renal , Fatores de RiscoRESUMO
Nephrotoxicity remains an important complication of chemotherapy. There are many different types of kidney injury that can results from anti-cancer drugs, including: acute and chronic tubular injuries, various podocytopathies, crystal nephropathies, thrombotic microangiopathy, and electrolyte wasting syndromes. All these pathologic changes, their diagnosis and treatment, as well as the preventive measures are shortly summarized in the article.
Assuntos
Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/prevenção & controle , Insuficiência Renal Crônica/induzido quimicamente , Insuficiência Renal Crônica/prevenção & controle , Doença Aguda , Antineoplásicos/efeitos adversos , Humanos , Túbulos Renais/efeitos dos fármacos , Nefrite Intersticial/induzido quimicamente , Fatores de RiscoRESUMO
Tumor lysis syndrome (TLS) is a serious adverse event observed in patients treated for hematologic malignancies and solid tumors, particularly those with a high proliferative rate. An abrupt and massive tumor cell lysis with release their contents into the circulation leads to a rapid development of hyperuricemia, hyperkalemia, hyperphosphatemia, followed by hypocalcemia. If not managed appropriately, these metabolic disturbances may result in acute kidney injury and in life-threatening cardiac complications and even death. This short review summarizes current strategies for diagnosis, risk assessment, prophylaxis, and therapy.
Assuntos
Neoplasias/complicações , Síndrome de Lise Tumoral/diagnóstico , Síndrome de Lise Tumoral/terapia , Humanos , Nefropatias/diagnóstico , Nefropatias/terapia , Neoplasias/terapia , Síndrome de Lise Tumoral/etiologiaRESUMO
Recent epidemiological studies show significant prevalence of chronic kidney disease (CKD) in the general population. Diuretics are critical in therapy ofvolume overload and hypertension commonly encountered in these patients. However, they frequently demonstrate relevant diuretic resistance, and from the other hand diuretic overdose may lead to dehydratation and worsening of kidney function. In this paper the main principles of diuretic treatment in CKD are described, including the diuretic agent and its dose selection, as well as adverse effects of the therapy.
Assuntos
Diuréticos/uso terapêutico , Hipertensão/tratamento farmacológico , Hipertensão/etiologia , Insuficiência Renal Crônica/complicações , Relação Dose-Resposta a Droga , Humanos , Resultado do TratamentoRESUMO
BACKGROUND: There is continuous growth of combined liver-kidney transplantation (CLKTx) numbers with remarkable outcomes, especially among patient with liver cirrhosis and end-stage renal disease. The aim was to present a single center experience. METHODS: Twenty patients (9 males) with a mean age of 48 (range: 20-62) years underwent CLKTx from 2005 to 2022. Indications were polycystic liver and kidney diseases (ADPKD) in 12 cases, cirrhosis due to hepatitis (4 patients), and 1 case of amyloidosis, alcoholic liver disease, nonalcoholic steatosis, and congenital hepatic fibrosis with concomitant glomerulonephritis. After hepatectomy, half of the patients had orthotopic liver transplantation with piggy-back technique, and the other had conventional technique. All but 1 recipient had biliary end-to-end anastomosis. 3 patients had preemptive kidney graft transplantation. 4 underwent simultaneous right-side nephrectomy due to volume of the right kidney. Kidney was transplanted from the separate incision after abdominal closure with typical anastomoses. Tacrolimus, mycophenolate mofetile, basiliximab, and steroids were applied for all recipients. RESULTS: Mean follow-up was 57.7 ± 54 months. No primary non-function of the grafts occurred. Delayed kidney graft function (DGF) occurred in 8 patients. Three-month, 1-year, and 5-year cumulative survival rates were: 90%, 80%, and 72% respectively. None of the patients required retransplantation, and 1 recipient returned to hemodialysis 19 months after transplantation. Preemptive kidney transplantation and simultaneous right-side nephrectomy were not significant for DGF and recipient survival. No deaths within the first year occurred in piggy-back technique. CONCLUSIONS: CLKTx is safe and effective in the treatment of both liver and kidney failure.
Assuntos
Transplante de Rim , Transplante de Fígado , Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem , Falência Renal Crônica/cirurgia , Estudos Retrospectivos , Sobrevivência de EnxertoRESUMO
Physiologically, magnesium plays an essential role in bone formation, neuromuscular stability and muscle contraction, and the consequences of its altered homeostasis may be serious. Magnesium deficiency and hypomagnesemia are common and under-recognized problems, which can cause a variety of symptoms and can also affect the other cations metabolism. In this review causes, clinical picture and management of hypomagnesemia and magnesium deficiency are discussed.
Assuntos
Homeostase , Deficiência de Magnésio/diagnóstico , Deficiência de Magnésio/terapia , Humanos , Magnésio/metabolismo , Deficiência de Magnésio/etiologia , Deficiência de Magnésio/metabolismoRESUMO
Hypermagnesemia, defined as a plasma total magnesium concentration greater than 1.2 mmol/l, is much less common than hypomagnesemia, however it may be also life-threatening. In this review causes, clinical presentation and treatment of hypermagnesemia is shortly reviewed.
Assuntos
Homeostase/fisiologia , Magnésio/sangue , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/terapia , Overdose de Drogas/diagnóstico , Overdose de Drogas/terapia , Humanos , Magnésio/intoxicação , Doenças Metabólicas/induzido quimicamente , Doenças Metabólicas/metabolismoRESUMO
An elevation of arterial blood pH called alkalosis remains an underestimated condition in hospitalized patients. Serious alkalosis can be associated with high risk of death. The disorder can be caused by increased concentration of bicarbonate (metabolic alkalosis) or decreased concentration of carbon dioxide (respiratory alkalosis). In most cases of metabolic alkalosis it is generated by vomiting or diuretic use, whereas respiratory alkalosis is provoked by hyperventilation associated with respiratory or neurological disorder. Maintenance of metabolic alkalosis is possible only in patients with impaired renal base excretion which is most often produced by hypochloremia. In both respiratory and metabolic alkaloses treatment depends on the underlying factor. In hyperventilation syndrome is based on behavioral therapy. In most cases of metabolic alkalosis the administration of sodium and potassium chloride forms a substantial part of therapy.
Assuntos
Alcalose/diagnóstico , Alcalose/terapia , Alcalose/etiologia , Alcalose Respiratória/diagnóstico , Alcalose Respiratória/etiologia , Alcalose Respiratória/terapia , Bicarbonatos/metabolismo , Dióxido de Carbono/metabolismo , Diagnóstico Diferencial , Diuréticos/efeitos adversos , Humanos , Hiperventilação/complicações , Doenças do Sistema Nervoso/complicações , Vômito/etiologiaRESUMO
Magnesium is the second most prevalent intracellular cation, which plays a critical role in many cellular processes, essential for life, especially for neuromuscular functioning, cardiovascular health and normal bone formation. Its homeostasis is tightly regulated by a dynamic interplay between intestinal absorption and renal excretion. Additionally, it is controlled through the reservoir in bone tissue. This review summarizes shortly the current knowledge of magnesium homeostasis important for the practitioner to better understand it's disorders.
Assuntos
Homeostase/fisiologia , Magnésio/metabolismo , Cálcio/metabolismo , Humanos , Absorção Intestinal/fisiologia , Eliminação Renal/fisiologia , Canais de Cátion TRPM/metabolismo , Transcitose/fisiologiaRESUMO
Amyloidoses form a group of diseases in which extracellular insoluble fibrils cause organ injury and failure. These aggregates are built of misfolded proteins. Current amyloidosis classification is based on the type of the precursor amyloid protein. Distribution of the amyloid fibrils can be localized or systemic. The two most common systemic diseases are: amyloid light chain (AL) amyloidosis, being a consequence of clonal expansion of plasma cells in the bone marrow, and amyloid A (AA) amyloidosis, secondary to chronic inflammatory disorders. Renal involvement remains a frequent clinical manifestation of both of them with clinical pattern of massive proteinuria and progressive renal failure. Early diagnosis and treatment is essential because of the progressive character of the disease. The goal of current treatment approaches is to decrease the amount of amyloidogenic proteins and depends on its type. Systemic amyloidosis remains a disease with poor prognosis, especially in patients with cardiac involvement.
Assuntos
Amiloidose/diagnóstico , Amiloidose/terapia , Nefropatias/diagnóstico , Nefropatias/terapia , Amiloidose/classificação , Amiloidose/complicações , Diagnóstico Precoce , Humanos , Nefropatias/classificação , Nefropatias/complicações , Prognóstico , Proteinúria/etiologiaRESUMO
BACKGROUND: Simultaneous liver and kidney transplants (SLKT) represent 1.1% of all liver transplants in Poland. Patients undergoing SLKT experience a longer operation time and concurrent kidney dysfunction may aggravate metabolic derangement associated with the procedure. The benefits of intraoperative dialysis (ioHD) in these patients have not been determined. METHODS: A retrospective observational study of all adult patients undergoing SLKT in our center from January 2009 till December 2016. RESULTS: Study group consisted of 10 patients with End-Stage Kidney Disease (0.9% of all liver transplants): 6 patients treated with ioHD during SLKT (group 1) and 4 patients managed conservatively (group 2). All recipients were on chronic dialysis. The mean calculated Model for End-Stage Liver Disease score was 21 ± 0.9 in group 1 and 30 ± 9.5 in group 2 (P = .009). The mean preoperative serum potassium was 4.7 ± 0,6 mmol/L in group 1 and 3.97 ± 1,02 in group 2. Intraoperative serum potassium levels were comparable between the groups, but the maximum lactate and minimum bicarbonate levels were significantly worse in group 2. Postreperfusion syndrome occurred in no patient. Dialysis circuit clotting occurred in 50% of ioHD. Six patients (2 in group 1) required renal replacement therapy after SLKT; no patient was on dialysis on discharge. Three patients died within 1 year after surgery (2 in group 2). CONCLUSIONS: No patient developed intraoperative hyperkalemia or postreperfusion syndrome. We observed a high frequency of circuit system clotting during ioHD. Clinical benefits of intraoperative hemodialysis during SLKT need to be determined in a larger study.