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1.
Mymensingh Med J ; 29(1): 21-31, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915331

RESUMO

This cross sectional study was done to compare serum levels of amylase and lipase between predialysis and maintenance haemodialysis chronic kidney disease (CKD) patients and also to find out their relationship between degrees of renal impairment in Mymensingh Medical College Hospital and National Institute of Kidney Diseases and Urology, Dhaka, Bangladesh from May 2016 to April 2017. A total of 80 patients were included purposively as study subjects and made into two groups namely predialysis CKD group comprising 50 patients and other as maintenance haemodialysis group comprising of 30 patients. Among the predialysis group majority of the CKD was caused by glomerulonephritis (48%) followed by diabetes (26%), HTN (2%) and large portion undiagnosed (24%) whereas in the haemodialysis group ESRD was caused by diabetes (46%) followed by glomerulonephritis (16%), HTN (13%) and undiagnosed (23%). This study showed that mean serum amylase (158±718U/L vs. 111±41U/L) did not significantly differ between study groups except being above reference level but serum lipase (739±888U/L vs. 434±214U/L) was significantly higher in the predialysis group. There was a correlation between rising serum creatinine with serum amylase and lipase.


Assuntos
Amilases/sangue , Lipase/sangue , Insuficiência Renal Crônica/enzimologia , Adulto , Bangladesh , Biomarcadores/sangue , Creatinina/sangue , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/terapia
2.
J Sci Food Agric ; 100(2): 846-854, 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-31646650

RESUMO

BACKGROUND: Pomegranate has antioxidant, cardioprotective and anti-inflammatory properties. We designed a crossover study aimed at determining if consumption of pomegranate juice (PJ) improves lipid profile and oxidative and inflammatory biomarkers of hemodialysis patients. Forty-one hemodialysis patients were randomly assigned to one of two groups: PJ-treated group receiving 100 mL of natural PJ immediately after their dialysis session three times a week and the control group receiving the usual care. After 8 weeks, a 4-week washout period was established and then the role of the groups was exchanged. Lipid profile, blood pressure and oxidative and inflammatory biomarkers were measured before and after each sequence. RESULTS: Based on the results of intention-to-treat analysis, triglycerides were decreased in PJ condition and increased in the controls. Conversely, high-density lipoprotein cholesterol was increased in PJ and decreased in the control group. Total and low-density lipoprotein cholesterol did not significantly change in either condition. Systolic and diastolic blood pressure significantly decreased in PJ condition. Total antioxidant capacity increased in PJ condition (P < 0.001) and decreased in the controls (P < 0.001). Conversely, malondialdehyde and interleukin-6 decreased in PJ (P < 0.001) and increased in the control group (P ≤ 0.001). The changes of these biomarkers were significantly different between the two conditions. CONCLUSIONS: Eight-week PJ consumption showed beneficial effects on blood pressure, serum triglycerides, high-density lipoprotein cholesterol, oxidative stress and inflammation in hemodialysis patients. © 2019 Society of Chemical Industry.


Assuntos
Doenças Cardiovasculares/metabolismo , Sucos de Frutas e Vegetais/análise , Insuficiência Renal Crônica/dietoterapia , Adulto , Idoso , Pressão Sanguínea , Doenças Cardiovasculares/imunologia , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/prevenção & controle , Estudos Cross-Over , Feminino , Humanos , Masculino , Malondialdeído/metabolismo , Pessoa de Meia-Idade , Estresse Oxidativo , Diálise Renal , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/metabolismo , Insuficiência Renal Crônica/terapia , Triglicerídeos/metabolismo
3.
Medicine (Baltimore) ; 98(42): e17628, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626146

RESUMO

BACKGROUND: The role of anticoagulation therapy for stroke prevention in older atrial fibrillation (AF) patients with chronic kidney disease (CKD) remains unclear. Therefore, we conducted a meta-analysis to explore the efficacy and safety of anticoagulation therapy in this population. METHODS: The Cochrane Library, PubMed, and Embase databases were systematically searched for studies reporting the effect of anticoagulation therapy in older patients with AF and CKD. The risk ratios (RRs) and 95% confidence intervals (CIs) were regarded as the risk estimates. A random-effects model selected was to evaluate the treatment outcomes. The presentations were based on the Preferred Reporting Items for reporting systematic reviews and meta-analyses statement. RESULTS: A total of 7 studies with 24,794 older patients with AF and CKD were included. The follow-up of the included studies ranged from 0.9 to 9.0 years. In older patients with no dialysis, compared with nonanticoagulants, anticoagulants reduced the risk of all-cause death (RR 0.66, 95% CI 0.54-0.79), but had comparable risks of ischemic stroke/transient ischemic attack (TIA, RR 0.91, 95% CI 0.46-1.79) and bleeding (RR 1.17, 95% CI 0.86-1.60). In older patients with dialysis, compared with nonanticoagulants, anticoagulants increased the risk of bleeding (RR 1.37, 95% CI 1.09-1.74), but had similar risks of ischemic stroke/TIA (RR 1.18, 95% CI 0.88-1.58) and death (RR 0.87, 95% CI 0.60-1.27). CONCLUSION: Compared with nonanticoagulation, anticoagulation therapy is associated with a reduced risk of death in older AF patients with nondialysis, but an increased risk of bleeding in older patients with dialysis.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Insuficiência Renal Crônica/complicações , Acidente Vascular Cerebral/prevenção & controle , Terapia Trombolítica/métodos , Fibrilação Atrial/complicações , Humanos , Diálise Renal , Insuficiência Renal Crônica/terapia , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento
4.
Nephrol Nurs J ; 46(5): 533-541, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31566348

RESUMO

Successful health care transition from pediatric to adult care emphasizes the need for a collaborative effort to employ systematic processes. The development of a structured health care transition program for adolescents with chronic kidney disease (CKD) was the goal of this quality improvement program. The non-experimental design included development of an individualized health care transition treatment plan and TRxANSITION Scale™ application of the transition plan with patient evaluation; success designated full transition to adult care. Of the 19 patients enrolled, 74% had CKD, and 26% were renal transplant recipients. TRxANSITION Scale variables with the highest Pearson Correlation coefficients for total scores and strong positive relationships were self-management, insurance, and school. Four participants successfully transitioned. Purposeful, interprofessional health care transition preparation provides youth with CKD ongoing access to subspecialists, promotes self-care, and allows continued support of long-term health care planning. This evidence-based project adds to the body of knowledge for a topic that has proven to be challenging and often difficult for patients, families, and providers.


Assuntos
Modelos Organizacionais , Insuficiência Renal Crônica/terapia , Transição para Assistência do Adulto/organização & administração , Adolescente , Humanos
5.
JAMA ; 322(13): 1294-1304, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573641

RESUMO

Importance: Chronic kidney disease (CKD) is the 16th leading cause of years of life lost worldwide. Appropriate screening, diagnosis, and management by primary care clinicians are necessary to prevent adverse CKD-associated outcomes, including cardiovascular disease, end-stage kidney disease, and death. Observations: Defined as a persistent abnormality in kidney structure or function (eg, glomerular filtration rate [GFR] <60 mL/min/1.73 m2 or albuminuria ≥30 mg per 24 hours) for more than 3 months, CKD affects 8% to 16% of the population worldwide. In developed countries, CKD is most commonly attributed to diabetes and hypertension. However, less than 5% of patients with early CKD report awareness of their disease. Among individuals diagnosed as having CKD, staging and new risk assessment tools that incorporate GFR and albuminuria can help guide treatment, monitoring, and referral strategies. Optimal management of CKD includes cardiovascular risk reduction (eg, statins and blood pressure management), treatment of albuminuria (eg, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers), avoidance of potential nephrotoxins (eg, nonsteroidal anti-inflammatory drugs), and adjustments to drug dosing (eg, many antibiotics and oral hypoglycemic agents). Patients also require monitoring for complications of CKD, such as hyperkalemia, metabolic acidosis, hyperphosphatemia, vitamin D deficiency, secondary hyperparathyroidism, and anemia. Those at high risk of CKD progression (eg, estimated GFR <30 mL/min/1.73 m2, albuminuria ≥300 mg per 24 hours, or rapid decline in estimated GFR) should be promptly referred to a nephrologist. Conclusions and Relevance: Diagnosis, staging, and appropriate referral of CKD by primary care clinicians are important in reducing the burden of CKD worldwide.


Assuntos
Insuficiência Renal Crônica , Complicações do Diabetes/tratamento farmacológico , Progressão da Doença , Taxa de Filtração Glomerular , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Prognóstico , Encaminhamento e Consulta , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Medição de Risco
7.
Ecotoxicol Environ Saf ; 185: 109684, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31541948

RESUMO

Bisphenol A (BPA) accumulates in patients with chronic kidney disease (CKD), and hemodialysis filters may contribute to bisphenol burden in patients on hemodialysis (HD). The serum levels of BPA and three BPA analogs, namely, bisphenol B (BPB), bisphenol S (BPS), and bisphenol F (BPF), in 58 patients with CKD, 66 patients on dialysis therapy and 30 healthy control were investigated. The content of four bisphenols (BPs) was also examined in three types of dialysis filters, followed by an in vitro elution experiment to test the release of BPs from the dialysis filters. The serum levels of BPA (r = -0.746, p < 0.05) and BPS (r = -0.433, p < 0.05) in 58 CKD patients and 30 healthy control were correlated with the decrease in estimated glomerular filtration rate. The serum levels of BPs in the HD patients were higher than those in the peritoneal dialysis patients (p < 0.05). In the in vitro study on the BP contents in dialysis filters, BPA was the main form of the BPs in the polysulfone membrane (20.86 ±â€¯1.18 ng/mg) and in the polyamide membrane (18.70 ±â€¯2.88 ng/mg), and a modicum of BPS (0.01 ±â€¯0.01 ng/mg) was detected in the polyethersulfone membrane. The results of the elution experiment were in accordance with the results of BPs content in the dialysis filters. Insufficient renal function may lead to BPs accumulation in patients with CKD, and BPs in dialysis products may cause BPs burden in patients on HD.


Assuntos
Compostos Benzidrílicos/sangue , Fenóis/sangue , Diálise Renal/métodos , Insuficiência Renal Crônica/sangue , Sulfonas/sangue , Taxa de Filtração Glomerular , Humanos , Membranas Artificiais , Polímeros/química , Insuficiência Renal Crônica/terapia , Sulfonas/química
8.
Rev Med Suisse ; 15(662): 1629-1632, 2019 Sep 11.
Artigo em Francês | MEDLINE | ID: mdl-31508915

RESUMO

Arterial hypertension (HT) affects hundreds millions of people suffering from chronic kidney disease: it could be a cause or a consequence. HT can aggravate their prognosis and then lead to a very high cardiovascular morbidity and mortality. HT must be systematically screened and optimally taken care of. However, general practitioners actually lack unambiguous guidelines regarding patients with kidney diseases. This article underlines the necessity and modalities of a precise diagnosis, and aims to discuss the last studies supporting new and better therapeutic targets. The pathophysiological aspects of HT in chronic kidney diseases are also discussed.


Assuntos
Hipertensão/complicações , Hipertensão/terapia , Insuficiência Renal Crônica/complicações , Humanos , Hipertensão/mortalidade , Guias de Prática Clínica como Assunto , Prognóstico , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Fatores de Risco
9.
Acta Diabetol ; 56(12): 1323-1331, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31494747

RESUMO

AIMS: Nephropathic patients show higher levels of advanced glycation end products (AGEs) and oxidized human serum albumin (HSAox) compared to healthy subjects. These two classes of compounds are formed as the result of oxidative insults; for this reason, they can be useful oxidative stress biomarkers. The present study examines the variation of AGEs and HSAox in hemodialysis (HD) patients before and after dialysis session, evaluating the impact of different dialytic techniques and filters on their removal. METHODS: A total of 50 healthy subjects (control group) and 130 HD patients were enrolled in the study. Hemodialysis patients were subdivided based on dialytic techniques: 109 in diffusive technique and 22 in convective technique. We monitored HSAox, AGEs and other laboratory parameters at early morning in healthy subjects and in HD patients before and after the dialysis procedures. RESULTS: The level of HSAox decreases after a single dialytic session (from 58.5 ± 8.8% to 41.5 ± 11.1%), but the concentration of total AGEs increases regardless of adopted dialytic techniques (from 6.8 ± 5.2 µg/ml to 9.2 ± 4.4 µg/ml). In our study, levels of HSAox and total AGEs are similar in diabetic and non-diabetic HD patients. The increase in total AGEs after dialysis was only observed using polysulfone filters but was absent with polymethacrylate filters. CONCLUSIONS: HSAox is a simple and immediate method to verify the beneficial effect of a single dialysis session on the redox imbalance, always present in HD patients. Total AGEs assayed by ELISA procedure seem to be a less reliable biomarker in this population.


Assuntos
Biomarcadores , Produtos Finais de Glicação Avançada/sangue , Diálise Renal , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Albumina Sérica Humana/metabolismo , Biomarcadores/análise , Biomarcadores/sangue , Estudos de Casos e Controles , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/terapia , Feminino , Produtos Finais de Glicação Avançada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Oxirredução , Estresse Oxidativo/fisiologia , Polímeros/química , Ácidos Polimetacrílicos/química , Prognóstico , Diálise Renal/métodos , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/epidemiologia , Albumina Sérica Humana/análise , Sulfonas/química , Resultado do Tratamento
10.
Postgrad Med ; 131(7): 539-545, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31482757

RESUMO

Objectives: Cardiac autonomic nervous system (ANS) dysfunction is a common feature in patients receiving hemodialysis (HD) therapy, whilst is associated with an increased risk of ventricular arrhythmias and sudden cardiac death. The aim of this study is to investigate and compare the hemodynamic changes and responses of ANS function in HD patients using pupillometry and Heart Rate Variability (HRV) parameters. Methods: Sixteen chronic kidney diseases (CKD) patients receiving HD (52.18 ± 17.7 years) underwent both pupillometric measurements using a portable handheld pupil-measuring device and standard HRV analysis pre HD, every hour and 30 min post-HD session under two different scenarios: at rest while the patient resting at HD bed and when the patient performed a single bout of intradialytic aerobic exercise lasting for 45 min during the second hour of the HD therapy. Results: No significant changes in ANS values were observed in neither of the pupillometric and the HRV values pre HD, for each hour and post-HD session. HRV parameters were significantly correlated with pupillometric parameters at pre HD and immediately after the single bout of intradialytic exercise. ANS activity did not differ during the conventional HD session and during the session included intradialytic exercise. Moreover, sympatho-vagal balance indices deriving from pupillometric assessment showed beneficial changes after the exercise event. Conclusion: Pupillometry is a promising and robust technique with fewer artifacts compared to HRV especially in studies involving exercise sessions. Thus, pupillometry can be used as a complementary tool in the evaluation of cardiac autonomic dysfunction.


Assuntos
Doenças do Sistema Nervoso Autônomo/fisiopatologia , Exercício/fisiologia , Frequência Cardíaca/fisiologia , Pupila/fisiologia , Diálise Renal , Insuficiência Renal Crônica/terapia , Adulto , Idoso , Sistema Nervoso Autônomo/fisiopatologia , Humanos , Pessoa de Meia-Idade , Insuficiência Renal Crônica/fisiopatologia
11.
Pan Afr Med J ; 33: 91, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489069

RESUMO

Introduction: Haemodialysis (HD) which is a form of renal replacement therapy commonly prescribed for patients with chronic kidney disease (CKD). However, it is not without deleterious haemodynamic responses which may occur either during or immediately after the termination of the procedure. These may include hypotension or hypertension. Methods: This was a retrospective study that reviewed chronic kidney disease (CKD) patients on maintenance haemodialysis at the renal unit of University of Calabar Teaching Hospital, Calabar, Nigeria. In all, 71 patients were reviewed but only 64 patients had complete data for analysis. Socio-demographic, clinical and biochemical data were obtained from the records in the dialysis unit. Results: There were more males 38 (59.4%) than females 26 (40.6%) in the study. The mean age was 51.71±15.43 years and 43.04±14.03years for males and females respectively. The prevalence of intradialysis hypertension 29 (45.3%) was higher than that of intradialysis hypotension 20 (31.3%) and the commonest cause of CKD requiring haemodialysis was diabetic nephropathy. The factors associated with intradialysis hypotension were lower post-dialysis systolic blood pressure (PDSBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and less number of antihypertensive medications; while the factors associated with intradialysis hypertension were higher post-dialysis systolic blood pressure (SBP), MAP, greater number of antihypertensive medications and longer duration of haemodialysis. Conclusion: Our study shows that there are several modifiable factors associated with blood pressure fluctuations among CKD patients on maintenance haemodialysis in the renal unit of the University of Calabar Teaching Hospital, Calabar.


Assuntos
Hipertensão/epidemiologia , Hipotensão/epidemiologia , Diálise Renal/métodos , Insuficiência Renal Crônica/terapia , Adolescente , Adulto , Idoso , Anti-Hipertensivos/administração & dosagem , Pressão Sanguínea , Feminino , Hospitais de Ensino , Humanos , Hipertensão/etiologia , Hipotensão/etiologia , Masculino , Pessoa de Meia-Idade , Nigéria , Prevalência , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária , Fatores de Tempo , Adulto Jovem
12.
Nephrol Nurs J ; 46(4): 375-394, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31490048

RESUMO

Adult patients on hemodialysis experience a high prevalence of poor oral health and periodontitis. The chronic inflammation associated with poor periodontal health can increase the risk of cardiovascular disease and mortality among patients on hemodialysis. A systematic review of research articles published from 2012-2018 was conducted to synthesize current literature on the subject. Forty-three articles were identified. Findings were summarized into two categories: clinical measurements and lifestyle/quality of life. We suggest the development, implementation, and evaluation of oral health nursing interventions and periodontal treatments among patients on hemodialysis.


Assuntos
Saúde Bucal/estatística & dados numéricos , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/terapia , Adulto , Humanos
13.
Medicine (Baltimore) ; 98(36): e16812, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490367

RESUMO

Chronic kidney disease (CKD)-associated pruritus is one of the most common symptoms found in patients who undergo dialysis for CKD, leading to a compromised quality of life. This study aimed to investigate the association between CKD-associated pruritus and the quality of life in patients undergoing hemodialysis in Pakistan.A cross-sectional multicenter study was carried out from July 2016 to April 2017 in 2 tertiary care hospitals in Pakistan. Patients aged 18 years and above of both genders, undergoing hemodialysis, understood the Urdu language, and were willing to participate; were included.Of 354 recruited patients with a response rate of 100%, majority (66.1%) of the patients were males. The median (intra-quartile range [IQR]) age of patients was 42.0 [34.0-50.0] years. The prevalence of pruritus was 74%. The median [IQR] score for pruritus was 10.0 (out of possible 25) [8.0-12.0]. Multivariate linear regression revealed a statistically significant association between CKD-associated pruritus with age of patients (ß = 0.031; 95% confidence interval [CI] = 0.002-0.061; P = .038), duration of CKD (ß = -0.013; 95% CI = -0.023 --0.003; P = .014) and quality of life (ß= -0.949; 95% CI = -1.450; -0.449). The median [IQR] score for health-related quality of life was 52.00 [43.00-58.00].Prevalence of CKD-associated pruritus was reported to be 74% and it negatively affected the patient's quality of life. Patients with moderate to severe CKD-associated pruritus have poor quality of life. With an increase in intensity of pruritus, the QOL score decreased among the patients undergoing hemodialysis.


Assuntos
Prurido/epidemiologia , Prurido/etiologia , Qualidade de Vida , Insuficiência Renal Crônica/complicações , Adulto , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Prevalência , Diálise Renal/métodos , Insuficiência Renal Crônica/terapia , Índice de Gravidade de Doença , Fatores Socioeconômicos
14.
Angiol Sosud Khir ; 25(3): 177-181, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31503263

RESUMO

Analysed herein are the results of treating a total of 29 patients presenting with stage IV chronic kidney disease (CKD) induced by ischaemic nephropathy. All patients had renal artery stenosis more than 80%, decreased glomerular filtration rate (GFR) below 30 ml/min/1.73m2 and were regarded by the nephrologists as potential candidates for programmed haemodialysis. After preparation aimed at preventing contrast-induced nephropathy all patients underwent stenting of the stenosed renal arteries. In the early postoperative period, 21 patients were found to have stabilization of the GFR with a tendency to increase. One woman developed acute renal failure requiring renal replacement therapy by means of haemodialysis. During the follow-up period from 1 to 5 years, 26 patients showed no progression of azotemia. CKD changed to stage III in 15 patients (p<0.005). Twenty-three (84%) patients during the follow-up period developed no new cardiovascular events. Hence, performing renal revascularization for renal artery stenosis >80% revealed in patients with stage IV CKD promotes prolongation of the dialysis-free period.


Assuntos
Taxa de Filtração Glomerular , Falência Renal Crônica , Obstrução da Artéria Renal , Diálise Renal , Insuficiência Renal Crônica , Progressão da Doença , Feminino , Humanos , Rim , Falência Renal Crônica/terapia , Insuficiência Renal Crônica/terapia
15.
Medicine (Baltimore) ; 98(33): e16745, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415370

RESUMO

RATIONALE: Malformative uropathies represent a major cause of Chronic Kidney Disease (CKD) in children. Genitourinary system is the most frequent and sever affected in Prune-Belly syndrome cases. That is why the findings of early diagnosis and vigilant monitoring for these situations remain a major challenge for the medical team. PATIENT CONCERNS: We present the clinical course of a 10 years old child with diagnosis of Prune-Belly syndrome. A urinary tract abnormality was suspected starting 25 weeks of gestation, when a routine ultrasound showed oligohydramnios, increased size urinary bladder, bilateral hydronephrosis and megaureters, thin abdominal wall. DIAGNOSIS: Prenatal suspicion of Prune-Belly syndrome plays a deciding role in renal disease progression. A detailed clinical exam at birth established the diagnosis of Prune-Belly syndrome. Renal ultrasound confirmed bilateral grade III hydronephrosis and megaureters, with empty bladder, suggesting an obstruction at this level. A persistent urachus was confirmed by catheterization. Later it was used for imaging study that showed bilateral high grade reflux. INTERVENTIONS: The main goal of any treatment is to preserve kidney function. Treatment options depend on the clinical picture. The pregnancy was closely monitorized, but fetal distress appeared so early labor was induced at 32 weeks. At beginning a temporary catheter was placed into the urachus which expressed urine. The urachus drain was left in place until the age of 6 weeks, when a bilateral ureterostomy was performed. Skeletal and genital malformations were present too; the child has undergone several surgeries to solve these abnormalities. OUTCOMES: At the age of 10 years, he is a well-adapted child. He has had fewer than 3 urinary tract infections per year. Long term follow-up showed a relatively slow decline in the estimated Glomerular Filtration Rate in our child (62 ml/1.73m/min). LESSONS: This case suggests that induced early labor could prove beneficial for early upper urinary tract decompression through earlier access to surgery. This is an option especially in situations or region where vesicoureteric or vesicoamniotic shunt placement is not available.


Assuntos
Síndrome do Abdome em Ameixa Seca/diagnóstico por imagem , Insuficiência Renal Crônica/terapia , Anormalidades Múltiplas , Criança , Diagnóstico Diferencial , Seguimentos , Humanos , Masculino , Síndrome do Abdome em Ameixa Seca/complicações , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Ultrassonografia Pré-Natal
16.
Pan Afr Med J ; 33: 71, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31448033

RESUMO

The authors report the first case of successful peritoneal dialysis (PD) in a developing country performed about a 13-year-old adolescent followed-up for stage V chronic kidney disease (CKD) with anuria. After 3 months of hemodialysis, the parents opted for continuous ambulatory peritoneal dialysis (CAPD) as they wished to return home located 121km from Dakar. After PD catheter insertion, the plan proposed to the patient consisted 3-4 hours stasis of isotonic dialysate during the day and a night stasis of 8 hours of icodextrin for an injection volume of 1L per session. The patient and his mother were trained and assessed on the PD technique. After dialysis adequacy was tested while hospitalised, they were able to return home and continued the sessions following the same plan prescribed and while keeping in touch, by telephone, with the medical team. The technique assessment at the day hospital every 2 weeks revealed dialysis adequacy and satisfactory tolerance of PD at home after 04 months of observation. It was the first case of successful CAPD in the pediatrics unit in this context. Scaling this technique is a challenge for the pediatric nephrologist in developing countries like Senegal.


Assuntos
Hemodiálise no Domicílio/métodos , Diálise Peritoneal Ambulatorial Contínua/métodos , Insuficiência Renal Crônica/terapia , Adolescente , Países em Desenvolvimento , Soluções para Diálise/química , Humanos , Icodextrina/química , Masculino , Diálise Renal , Senegal
17.
Artigo em Inglês | MEDLINE | ID: mdl-31450673

RESUMO

Chronic kidney disease (CKD) has considerable effects on the quality of life of patients, impairing everyday activities and leading to lifestyle changes, as well as affecting body image and intimate relationships. Our aim was to describe the experience of female patients with CKD at an ambulatory dialysis unit regarding body changes and sexuality. A qualitative phenomenological study exploring how 18 female patients, treated at the dialysis unit of a Spanish hospital, perceived their sexuality and intimate relationships. Data were collected using in-depth interviews, researcher field notes, and patients' personal letters. A thematic analysis was performed. Four main themes arose from the data describing the experience of how CKD impacts body changes and sexuality: (a) Accepting body changes, (b) The catheter, the fistula, and body image, (c) Experiencing a different sexuality, and (d) The catheter, the fistula, and sexuality. Patients experienced changes in their body, perceiving it as being bloated or deformed, together with overall decline. The catheter and/or the fistula triggered changes in the way the women dress in an attempt to hide port sites. Women experience sexuality changes, affecting sexual desire and satisfaction. The presence of catheters was found to be the most cumbersome during sexual acts.


Assuntos
Imagem Corporal , Libido , Diálise Renal , Adulto , Idoso , Instituições de Assistência Ambulatorial , Feminino , Humanos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Qualidade de Vida , Insuficiência Renal Crônica/terapia , Espanha
18.
Adv Exp Med Biol ; 1165: 625-659, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399988

RESUMO

Renal fibrosis is the common pathway for progression of chronic kidney disease (CKD) to end stage of renal disease. It is now widely accepted that the degree of renal fibrosis correlates with kidney function and CKD stages. The key cellular basis of renal fibrosis includes activation of myofibroblasts, excessive production of extracellular matrix components, and infiltration of inflammatory cells. Many cellular mechanisms responsible for renal fibrosis have been identified, and some antifibrotic agents show a greater promise in slowing down and even reversing fibrosis in animal models; however, translating basic findings into effective antifibrotic therapies in human has been limited. In this chapter, we will discuss the effects and mechanisms of some novel antifibrotic agents in both preclinical studies and clinical trials.


Assuntos
Rim/patologia , Insuficiência Renal Crônica/terapia , Animais , Progressão da Doença , Matriz Extracelular , Fibrose , Humanos , Miofibroblastos
19.
Adv Exp Med Biol ; 1165: 661-670, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399989

RESUMO

Renal failure is one of the most important causes of mortality and morbidity all over the world. Acute kidney injury (AKI) is a major clinical problem that affects up to 5% of all hospitalized patients. Although the kidney has a remarkable capacity for regeneration after acute injury, the mortality among patients with severe AKI remains dismally high, and in clinical practice, most patients cannot be cured completely and suffer from chronic kidney disease (CKD). Recently, the incidence and prevalence of CKD have increased, largely as a result of the enhanced prevalence of diabetes and obesity. The progressive nature of CKD and the ensuing end-stage renal disease (ESRD) place a substantial burden on global healthcare resources. Currently, dialysis and transplantation remain the only treatment options. Finding new therapeutic methods to fight AKI and CKD remains an ongoing quest. Although the human renal histological structure is complex, stem cell therapies have been applied to repair injured kidneys. The curative effects of mesenchymal stem cells (MSCs), hematopoietic stem cells (HSCs), induced pluripotent stem cells (iPSCs), and nephron progenitor cells (NPCs) on renal repair have also been reported by researchers. This review focuses on stem cell therapy and mechanisms for renal injury repair.


Assuntos
Lesão Renal Aguda/terapia , Terapia Baseada em Transplante de Células e Tecidos , Células-Tronco/citologia , Humanos , Rim , Falência Renal Crônica/terapia , Néfrons , Insuficiência Renal Crônica/terapia
20.
G Ital Nefrol ; 36(4)2019 Jul 24.
Artigo em Italiano | MEDLINE | ID: mdl-31373463

RESUMO

People with a chronic kidney condition can live with their disease for several years, during which the illness becomes "an integral aspect of life" and requires "an arduous and continuous process of adaptation at multiple levels: cognitive, emotional and physical". Often, communicating with doctors is not helpful to these patients in understanding what is happening and reorganizing their lives, as ineffective communication strategies are employed. It is in fact necessary to overcome obstacles such as the use of incomprehensible technical language, ambiguity, the lack of communication training and the abundance of stressful situations. Chronically ill patients have the right to be informed in a simple, clear and impartial way about their condition and its possible treatments; this information will help them manage their kidney disease, "accept" it and find the motivation to adhere to medical prescriptions over time.


Assuntos
Barreiras de Comunicação , Nefrologia , Relações Enfermeiro-Paciente , Relações Médico-Paciente , Diálise Renal/psicologia , Insuficiência Renal Crônica/psicologia , Esgotamento Profissional , Comunicação , Humanos , Acontecimentos que Mudam a Vida , Educação de Pacientes como Assunto , Insuficiência Renal Crônica/terapia
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