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1.
Angiology ; 71(3): 249-255, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31808357

RESUMO

Contrast-induced nephropathy (CIN) is one of the most important complications after invasive cardiovascular procedures. The neutrophil-to-lymphocyte ratio (NLR), mean platelet volume-to-lymphocyte ratio (MPVLR), and platelet-to-lymphocyte ratio (PLR) may be markers of the risk of CIN. We aimed to investigate the association of these indices with the development of CIN in patients with ST-elevation myocardial infarction and non-ST-elevation-acute coronary syndrome who underwent percutaneous coronary intervention. We retrospectively collected the data of patients with ACS after coronary angiography (CA); 564 patients were included (mean age, 62.3 ± 13.0 years; 41.1% female). We compared 62 (10.9%) patients who developed CIN and 502 patients who did not, after CA in terms of NLR, PLR, and MPVLR. Patients who developed CIN had significantly higher MPVLR, NLR, and PLR; the MPVLR (P ≤ .001) was an independent predictor of CIN. NLR, MPVLR, and PLR are simple, cheap, and easily accessible tests that can predict CIN; the MPVLR was the strongest of these predictors.


Assuntos
Síndrome Coronariana Aguda/fisiopatologia , Angiografia Coronária , Neutrófilos/citologia , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Adulto , Idoso , Plaquetas/citologia , Angiografia Coronária/métodos , Feminino , Humanos , Masculino , Volume Plaquetário Médio/métodos , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/metabolismo , Intervenção Coronária Percutânea/métodos , Insuficiência Renal/diagnóstico , Insuficiência Renal/metabolismo , Estudos Retrospectivos , Fatores de Risco
2.
J Cardiothorac Surg ; 14(1): 191, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699143

RESUMO

BACKGROUND: Mild preoperative renal dysfunction (RD) is not rare in patients receiving isolated cardiopulmonary coronary artery bypass grafting (CCABG). However, there are not too many studies about the impact of mild preoperative RD on in-hospital and follow-up outcomes after isolated CCABG. This single-centre, retrospective propensity score matching study designed to study the impact of mild preoperative RD on in-hospital and long-term outcomes after first isolated CCABG. METHODS: After propensity score matching, 1144 patients with preoperative estimated glomerular filtration rate (eGFR) of more than 60 ml/min/1.73 m2 receiving first isolated CCABG surgery from January 2012 to December 2015 entered the study, who were divided into 2 groups: A group (eGFR ≥90 ml/min/1.73 m2, n = 572) and B group (eGFR of 60-89 ml/min/1.73 m2, n = 572). The in-hospital and long-term outcomes were recorded and analyzed. The mean follow-up time was 54.4 ± 10.7 months. Acute kidney injury (AKI) was defined and classified according to the Acute Kidney Injury Network (AKIN) criteria. RESULTS: The 2 propensity score-matched groups had similar baseline and procedure except the baseline eGFR. There were 8 patients died in A group (mortality is 1.4%) and 14 died in B group (mortality is 2.5%) during the in hospital and 30-day postoperatively(χ2 = 1.159, p = 0.282). There were totally 38 patients lost to follow-up, 18 in group A and 20 in group B. 21 patients died in group A and 37 died in group B during the follow-up, and long-term survival in group A was higher than in group B (96.2% vs 93.1%, χ2 = 4.336, p = 0.037). Comparing with group A, group B was associated with an increased rates and severity of AKI postoperatively (total AKI: 62 vs 144. AKIN stageI: 54 vs 113; AKIN stageII: 6 vs 22; AKIN stageIII: 2 vs 9, p<0.0001). During follow-up, group B also had a higher rate of new onset of dialysis (0 vs 6, χ2 = 4.432, p = 0.039). Multivariable logistic regression showed that comparing with A group, the HR for long-term mortality and new onset of dialysis in B group was 1.67 and 1.52 respectively (95%CI 1.09-2.90, p = 0.035; 95%CI 1.14-2.49, p = 0.027). CONCLUSIONS: Comparing with normal preoperative renal function, patients with mild preoperative RD had a similar in-hosptial mortality, but with an increased in-hosptial rates and severity of AKI, and with a decreased long-term survival and increased long-term new onset of dialysis.


Assuntos
Ponte de Artéria Coronária , Complicações Pós-Operatórias/etiologia , Insuficiência Renal/complicações , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/terapia , Idoso , Feminino , Seguimentos , Taxa de Filtração Glomerular , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Período Pré-Operatório , Pontuação de Propensão , Diálise Renal , Insuficiência Renal/diagnóstico , Insuficiência Renal/mortalidade , Insuficiência Renal/terapia , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento
3.
Urology ; 134: e3-e4, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31585197

RESUMO

Primary Hyperoxaluria is a rare autosomal recessive hereditary disorder due to deficient alanine-glyoxylate aminotransferase enzyme with defective glyoxylate metabolism leading to excessive oxalate production and deposition into the tissues (oxalosis). Deposition of excessive calcium oxalates in nephrons leads to crystallization (nephrocalcinosis) which increases risk for end-stage renal disease. We are presenting a case of primary hyperoxaluria type I confirmed with genetic studies.


Assuntos
Hiperoxalúria Primária , Rim/diagnóstico por imagem , Nefrocalcinose , Oxalatos , Transaminases/genética , Humanos , Hiperoxalúria Primária/diagnóstico , Hiperoxalúria Primária/genética , Hiperoxalúria Primária/cirurgia , Processamento de Imagem Assistida por Computador/métodos , Lactente , Transplante de Rim/métodos , Transplante de Fígado/métodos , Masculino , Mutação , Nefrocalcinose/diagnóstico por imagem , Nefrocalcinose/etiologia , Oxalatos/sangue , Oxalatos/metabolismo , Prognóstico , Diálise Renal/métodos , Insuficiência Renal/diagnóstico , Insuficiência Renal/etiologia , Insuficiência Renal/terapia , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos
4.
BMJ Case Rep ; 12(8)2019 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-31383675

RESUMO

Hypercalcaemia, renal dysfunction, anaemia and bone lesions (CRAB) are a constellation of signs and symptoms that are collectively referred to as the CRAB features. When present together, multiple myeloma (MM) should be at the top of the differential diagnosis. We present a 69-year-old man who presented with severe body aches and bone pain in his ribs and pelvis, associated with fatigue and constipation. He was found to have hypercalcaemia, acute kidney injury, anaemia and numerous lytic lesion on chest imaging. Physical examination and imaging were unremarkable for any enlarged lymph nodes. The patient was initially suspected to have multiple myeloma, however, serum and urine protein electrophoresis, and serum free light chain assays were negative. The patient was ultimately diagnosed with diffuse large B cell lymphoma based on a bone marrow biopsy. This case highlights the fact that presence of hypercalcaemia, renal dysfunction, anaemia and bone lesions are not usually specific for MM.


Assuntos
Anemia/diagnóstico , Doenças Ósseas/diagnóstico , Hipercalcemia/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Insuficiência Renal/diagnóstico , Idoso , Anemia/etiologia , Doenças Ósseas/etiologia , Diagnóstico Diferencial , Humanos , Hipercalcemia/etiologia , Linfoma Difuso de Grandes Células B/complicações , Masculino , Mieloma Múltiplo/diagnóstico , Insuficiência Renal/etiologia
5.
Saudi J Kidney Dis Transpl ; 30(4): 825-831, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31464239

RESUMO

Paraprotein gap is sometimes used as a screening tool in some autoimmune diseases, cancers, and screening for latent infections. The increase in the paraprotein gap in these diseases was hypothesized to be the result of increased levels of immunoglobulins, raising the total serum protein without any changes in serum albumin. Our aim was to assess the overall survival using novel chemotherapy, bortezomib compared to traditional ones and to assess if paraprotein gap could be used as a predictor of survival. Finally, we aimed to assess factors that could predict renal response in this population.


Assuntos
Mieloma Múltiplo/sangue , Paraproteínas/metabolismo , Insuficiência Renal/sangue , Microglobulina beta-2/sangue , Idoso , Antineoplásicos/uso terapêutico , Biomarcadores/sangue , Bortezomib/uso terapêutico , Feminino , Humanos , Masculino , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/mortalidade , Inibidores de Proteassoma/uso terapêutico , Insuficiência Renal/diagnóstico , Insuficiência Renal/mortalidade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
6.
J Korean Med Sci ; 34(30): e198, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31373183

RESUMO

BACKGROUND: Accurate volume measurement is important in the management of patients with congestive heart failure or renal insufficiency. A bioimpedance analyser can estimate total body water in litres and has been widely used in clinical practice due to its non-invasiveness and ease of results interpretation. To change impedance data to volumetric data, bioimpedance analysers use equations derived from data from healthy subjects, which may not apply to patients with other conditions. Bioelectrical impedance vector analysis (BIVA) was developed to overcome the dependence on those equations by constructing vector plots using raw impedance data. BIVA requires normal reference plots for the proper interpretation of individual vectors. The aim of this study was to construct normal reference vector plots of bioelectrical impedance for Koreans. METHODS: Bioelectrical impedance measurements were collected from apparently healthy subjects screened according to a comprehensive physical examination and medical history performed by trained physicians. Reference vector contours were plotted on the RXc graph using the probability density function of the bivariate normal distribution. We further compared them with those of other ethnic groups. RESULTS: A total of 242 healthy subjects aged 22 to 83 were recruited (137 men and 105 women) between December 2015 and November 2016. The centers of the tolerance ellipses were 306.3 Ω/m and 34.9 Ω/m for men and 425.6 Ω/m and 39.7 Ω/m for women. The ellipses were wider for women than for men. The confidence ellipses for Koreans were located between those for Americans and Spaniards without overlap for both genders. CONCLUSION: This study presented gender-specific normal reference BIVA plots and corresponding tolerance and confidence ellipses on the RXc graph, which is important for the interpretation of BIA-reported volume status in patients with congestive heart failure or renal insufficiency. There were noticeable differences in reference ellipses with regard to gender and ethnic groups.


Assuntos
Composição Corporal/fisiologia , Impedância Elétrica , Insuficiência Cardíaca/diagnóstico , Insuficiência Renal/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Adulto Jovem
8.
Int J Artif Organs ; 42(12): 765-769, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31277560

RESUMO

OBJECTIVE: CytoSorb® hemadsorption is an adjunctive therapy in order to reduce elevated cytokine levels of interleukin-6, interleukin-1, and tumor necrosis factor alpha. Here we present a successful administration of CytoSorb® hemadsorption in an immunocompromised pediatric patient with collapsing glomerulopathy, acute respiratory distress syndrome, and sepsis. DATA SOURCES: Clinical observations of one patient. STUDY SELECTION: Case report. DATA EXTRACTION: Data sources are clinical observation during patient management and patient's medical records if needed. The patient's consent was obtained prior to the study. DATA SYNTHESIS: A 17-year-old male with diarrhea was admitted to the hospital and was later found to have elevated creatinine levels and proteinuria. The renal biopsy was consistent with collapsing glomerulopathy and treatment with multi immunosuppressive agents including corticosteroids, mycophenolate mofetil, and rituximab coupled with several courses of hemodialysis and plasmapheresis were administered. During the hospital stay, Stenotrophomonas maltophilia bacteremia from the blood and the catheter cultures were identified. No clinical response was achieved, and patient developed severe sepsis despite antibiotics, intravenous immunoglobulin, and supportive management including albumin, platelet and erythrocyte concentrations, and fresh frozen plasma. CytoSorb® hemadsorption was then added to the ongoing treatment for three consecutive days. Subsequent to CytoSorb® hemadsorption, immediate laboratory and clinical response were observed. CONCLUSION: This is the successful clinical report of an immunocompromised teenager with collapsing nephropathy, sepsis, and multi-organ dysfunction syndrome treated with a combination of renal replacement therapy and CytoSorb® hemadsorption. The usage of CytoSorb® hemadsorption represents a novel approach to improve survival of the patients with multiple organ dysfunction and sepsis.


Assuntos
Antibacterianos/administração & dosagem , Infecções por Bactérias Gram-Negativas , Hemoperfusão/métodos , Insuficiência de Múltiplos Órgãos/terapia , Insuficiência Renal , Sepse , Stenotrophomonas maltophilia/isolamento & purificação , Adolescente , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/fisiopatologia , Infecções por Bactérias Gram-Negativas/terapia , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Masculino , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/etiologia , Diálise Renal/métodos , Insuficiência Renal/diagnóstico , Insuficiência Renal/etiologia , Insuficiência Renal/fisiopatologia , Insuficiência Renal/terapia , Sepse/microbiologia , Sepse/fisiopatologia , Sepse/terapia , Resultado do Tratamento
9.
BMC Res Notes ; 12(1): 445, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331365

RESUMO

OBJECTIVE: Tenofovir disoproxil fumarate (TDF) is a nucleotide analogue recommended in international HIV treatment guidelines. Purpose of this study was to estimate the long term effects of TDF on renal profile in a cohort of HIV patients in Ghana. Three hundred (300) consecutive HIV-positive patients who initiated TDF-based antiretroviral treatment in 2008 at the Korle-Bu Teaching Hospital were sampled. Creatinine clearance (CrCl) was calculated using the Cockcroft-Gault equation at baseline and renal impairment was defined as CrCl values of 30.0-49.9 mL/min (moderate renal impairment) and < 30 mL/min (severe renal impairment) as per institutional guidelines for renal function test. RESULTS: Median follow up time was 2.9 years (IQR 2.3-3.4 years). At study endpoint, 63 participants (21.0% [95% CI 6.5-26.1]) recorded CrCl rate below 50 mL/min indicating incident renal impairment, made up of 18.3% moderate renal impairment and 2.3% severe renal impairment. Factors associated with incidence of renal impairment were increasing age, decrease in creatinine clearance rate at baseline, WHO HIV stage III/IV and participants with BMI of < 18.5 kg/m2. Patients with identified renal impairment risk factors at ART initiation should be targeted and monitored effectively to prevent renal injury.


Assuntos
Infecções por HIV/tratamento farmacológico , Insuficiência Renal/diagnóstico , Tenofovir/uso terapêutico , Adulto , Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/uso terapêutico , Estudos de Coortes , Feminino , Gana/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Incidência , Rim/efeitos dos fármacos , Rim/fisiopatologia , Rim/virologia , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/induzido quimicamente , Insuficiência Renal/fisiopatologia , Tenofovir/efeitos adversos
10.
BMC Res Notes ; 12(1): 462, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31358035

RESUMO

OBJECTIVE: The aim of this study was to estimate the prevalence of renal insufficiency using estimated glomerular filtration rate (eGFR) among adult outpatients with normal SCr. RESULTS: A total of 414 patients with normal SCr were included in the study. Mean GFR (ml/min/1.73 m2) was 116.8 ± 43.5 using the MDRD equation and 90.5 ± 33.1 by the C-G formula. According to the MDRD formula, mild renal insufficiency (i.e. eGFR 60-89.9 ml/min/1.73 m2) was found in 21.5% of the patients and moderate renal insufficiency (i.e. eGFR 30-59.9 ml/min/1.73 m2) was found in 7.7%. According to the Cockcroft-Gault (C-G) formula, mild renal insufficiency was found in 38.2% and moderate renal insufficiency in 16.9% of the patients with normal SCr. In multivariate analysis, older age, female sex, a family history of kidney disease or other chronic diseases and high systolic blood pressure were associated with prevalent renal insufficiency depending on the formula used to estimate GFR. This study demonstrates the substantial prevalence of impaired renal function among Ethiopian adult outpatients with normal SCr. Including calculated estimates of GFR in routine laboratory reporting may help to facilitate the identification and thus optimal management of patients with renal insufficiency.


Assuntos
Rim/fisiopatologia , Insuficiência Renal/epidemiologia , Insuficiência Renal/fisiopatologia , Adulto , Fatores Etários , Idoso , Creatinina/sangue , Estudos Transversais , Etiópia/epidemiologia , Feminino , Taxa de Filtração Glomerular , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pacientes Ambulatoriais , Prevalência , Insuficiência Renal/sangue , Insuficiência Renal/diagnóstico , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais
11.
Forensic Sci Int ; 301: 271-277, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31195248

RESUMO

The determination of the role that drugs may have played in a death is an important part of the investigation into unexplained deaths. Renal impairment may lead to a reduction in drug excretion rate and therefore an accumulation of drugs or metabolites, leading to possible toxic or lethal effects. Creatinine levels are known to be stable in the post mortem period and in life can give an indication of kidney function. There are however widely reported limitations when using creatinine in isolation and so we investigated the usefulness of using estimated glomerular filtration rate (eGFR) for scoring an individual as having renal impairment using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. We analysed unpreserved vitreous for creatinine in 812 individuals using an isotope dilution mass spectrometry (ID-MS) traceable enzymatic. We found that the biochemical analysis of post mortem vitreous creatinine and subsequent calculation of eGFR is a useful adjunct to the standard testing that takes place during a post-mortem examination and can assist in death investigation. Using an eGFR of <60 mL/min/1.73 m2 gave a sensitivity of 94.3% and specificity of 97.3% when scoring an individual as having renal impairment. We therefore recommend the calculation of eGFR for the determination of possible renal impairment in post mortem investigations. It is, of course, always pertinent to interpret any results using a wealth of case information. Extreme caution should be exercised in cases where insufficient clinical information/history is available, particularly in cases in which there is suspected diabetic ketoacidosis, dehydration or hospitalisation prior to death.


Assuntos
Creatinina/metabolismo , Taxa de Filtração Glomerular , Insuficiência Renal/diagnóstico , Corpo Vítreo/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/metabolismo , Feminino , Toxicologia Forense , Humanos , Masculino , Espectrometria de Massas/métodos , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Adulto Jovem
12.
Clin Nephrol ; 92(2): 73-80, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31198168

RESUMO

BACKGROUND: Diabetic kidney disease (DKD) is the most common cause of end-stage renal disease (ESRD) worldwide. Clinical manifestations of DKD consist of a progressive increase in albuminuria and a decline in estimated glomerular filtration rate (eGFR). Hence, the diagnosis of DKD in patients with declining renal function without albuminuria is more difficult. Although there are several reports of such patients in other geographic regions, the data in this regard are limited. OBJECTIVE: To determine the prevalence of normoalbuminuria with renal impairment and the decline in eGFR relative to their albuminuric status in type 2 diabetes mellitus (T2DM) among Thai patients. MATERIALS AND METHODS: Retrospective review was conducted on medical records of T2DM patients at a tertiary referral hospital dated from January 1, 2013, until June 30, 2016. Based on study inclusion criteria, T2DM patients with renal impairment identified by an eGFR of less than 60 mL/min/1.73m2 were eligible. Albumin excretion rate was determined by urine albumin-to-creatinine ratio from a single random urine collection. RESULTS: Of the 4,597 patients with T2DM, 16.5% had an eGFR below 60 mL/min/1.73m2. The overall prevalence rates of normoalbuminuria, moderate proteinuria, and severe proteinuria were 45.4, 30.9, and 23.7%, respectively. In the normoalbuminuria group, the incidences of chronic kidney disease at stage 3a, 3b, and 4 were 67.5, 27, and 5.5%, respectively. None of the patients with stage 5 chronic kidney disease had normoalbuminuria. The decline in eGFR with normoalbuminuria was less significant than in positive albuminuria. CONCLUSION: The association of normoalbuminuria is common in DKD. The decline of renal function is slower in normoalbuminuria; however, the risk factors, clinical progression, and renal pathology in these patients need to be further explored.


Assuntos
Albuminúria/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/epidemiologia , Insuficiência Renal/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Albuminúria/diagnóstico , Nefropatias Diabéticas/diagnóstico , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Insuficiência Renal/diagnóstico , Estudos Retrospectivos
13.
Mayo Clin Proc ; 94(6): 1003-1014, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31171114

RESUMO

OBJECTIVE: To examine the frequency and outcomes of patients requiring renal replacement therapy (RRT) early after left ventricular assist device (LVAD) implantation. PATIENTS AND METHODS: We examined use of in-hospital RRT and outcomes in consecutive adults who underwent continuous-flow LVAD implantation from February 15, 2007, through August 8, 2017. Logistic regression was used to examine predictors of RRT. The associations of RRT with outcomes were examined using Cox proportional hazards regression. RESULTS: Of 354 patients who underwent LVAD implantation, 54 (15%) required in-hospital RRT. Patients receiving RRT had higher preoperative Charlson Comorbidity Index values (median, 5 vs 4; P=.03), Model for End-Stage Liver Disease scores (mean, 19.0 vs 14.5; P<.001), right atrial pressure (mean, 19.1 vs 13.4 mm Hg; P<.001), and estimated 24-hour urine protein levels (median, 357 vs 174 mg; P<.001) and lower preoperative estimated glomerular filtration rate (eGFR) (median, 43 vs 57 mL/min; P<.001) and measured GFR using 125I-iothalamate clearance (median, 33 vs 51 mL/min; P=.001) than those who did not require RRT. Approximately 40% of patients with eGFR less than 45 mL/min/1.73 m2 and 24-hour urine protein level greater than 400 mg required RRT vs 6% with eGFR greater than45 mL/min/1.73 m2 and without significant proteinuria. Lower preoperative eGFR, higher estimated 24-hour urine protein level, higher right atrial pressure, and longer cardiopulmonary bypass time were independent predictors of RRT after LVAD implantation. Of patients requiring in-hospital RRT, 18 (33%) had renal recovery, 18 (33%) required outpatient hemodialysis, and 18 (33%) died before hospital discharge. After median (Q1, Q3) follow-up of 24.3 (8.9, 49.6) months, RRT was associated with increased risk of death (adjusted hazard ratio [HR], 2.86; 95% CI, 1.90-4.33; P<.001) and gastrointestinal bleeding (adjusted HR, 4.47; 95% CI, 2.57-7.75; P<.001). CONCLUSION: In-hospital RRT is associated with poor prognosis after LVAD. A detailed preoperative assessment of renal function before LVAD may be helpful in risk stratification and patient selection.


Assuntos
Insuficiência Cardíaca/terapia , Ventrículos do Coração , Coração Auxiliar , Insuficiência Renal/diagnóstico , Terapia de Substituição Renal , Feminino , Taxa de Filtração Glomerular , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Proteinúria , Insuficiência Renal/terapia , Estudos Retrospectivos
14.
Clin Chim Acta ; 495: 377-381, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31078567

RESUMO

BACKGROUND: The prevalence and clinical risk factors of normoalbuminuric renal impairment have not yet been investigated in elderly Chinese populations. To clarify this, we conducted survey research on an elderly Chinese community population. METHODS: A total of 691 elderly community participants were included in this study. Normoalbuminuria was defined as a urinary albumin to creatinine ratio (ACR) <30 mg/g in morning urine. The estimated glomerular filtration rate (eGFR) and urinary alpha-1-microglobulin to creatinine ratio (MCR) were evaluated to assess normoalbuminuric kidney impairment in this elderly population. RESULTS: Among the whole cohort, 30.25% had albuminuria, 8.68% showed reduced eGFR and 49.78% had increased MCR. Normoalbuminuric subjects also showed a high prevalence of low eGFR and increased MCR (6.02% for reduced eGFR and 37.55% for increased MCR). Among the normoalbuminuric participants, the highest prevalence of increased MCR was found in the subjects with diabetes (50%), whereas the highest prevalence of low eGFR was found in women (8.11%). There was no significant difference in ln-MCR values between normoalbuminuric subjects with eGFR>60 and < 60 ml/min/1.73 m2. Age, gender, diabetes and hypertension were all independent risk factors of increased MCR. Diabetes and hypertension showed no statistical influence on decreased eGFR,whereas gender carried the highest risk for reduced eGFR. CONCLUSIONS: Albuminuria may have limited utility as a screening marker of renal injury, as a considerable proportion of the elderly population have renal impairment despite normoalbuminuria. Rather than focusing solely on patients with diabetes or hypertension, normoalbuminuric renal impairment should be given more attention within the overall elderly population.


Assuntos
Albuminúria/urina , Taxa de Filtração Glomerular , Túbulos Renais/fisiopatologia , Insuficiência Renal/diagnóstico , Idoso , alfa-Globulinas/urina , China , Creatinina/urina , Diabetes Mellitus , Feminino , Humanos , Masculino , Fatores de Risco , Fatores Sexuais
15.
G Ital Nefrol ; 36(2)2019 Apr.
Artigo em Italiano | MEDLINE | ID: mdl-30983182

RESUMO

After a quick description of the anatomopathology and physiopathology of renal failure, the Authors delve into the problem of assessing its medicolegal aspects in the fields of civil invalidity and social security. In Italy, civil invalidity involves protecting the psychological and physical welfare of the disabled, as sanctioned by law 118 of 1971; this law protects all citizens with a debilitating condition, including those who do not work or are not of working age. A disabled person is someone who, if of working age (between 18 and retirement) has a reduction of more than ⅓ (34%) of their general work capacity; if under or over the retirement age, they have a persistent difficulty in carrying out age-appropriate functions and tasks. In support of an application for being awarded civil invalidity, people can also refer to law no. 104 of 1992, which assesses social, relational and work disadvantages of a disabled person. INPS (Italian Social Security Institute) protection, on the other hand, is a social security protection based on health requirements (having a capacity for work which is reduced by more than ⅓, as established by law no. 222 of 1984), as well as on the following administrative requirement: having paid, as a worker, at least 260 weekly contributions, equivalent to five years of contribution and insurance, of which 156, equal to three years of contribution and insurance, were made in the five-year period preceding the date of submitting the application. If this is the case, the protected person, thus insured, can enjoy protection for their illness by virtue of the stipulations for social security.


Assuntos
Avaliação da Deficiência , Pessoas com Deficiência/legislação & jurisprudência , Insuficiência Renal/diagnóstico , Previdência Social , Fatores Etários , Peso Corporal , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Medicina Interna , Itália , Masculino , Nefrologia , Insuficiência Renal/etiologia , Insuficiência Renal/patologia , Insuficiência Renal/fisiopatologia , Fatores Sexuais , Avaliação da Capacidade de Trabalho
16.
Internist (Berl) ; 60(5): 485-501, 2019 05.
Artigo em Alemão | MEDLINE | ID: mdl-30997523

RESUMO

Kidney diseases are among the most frequently reported diseases with a poor prognosis that are diagnosed too late. According to current Kidney Disease Improving Global Outcomes (KDIGO) guidelines, diagnosis and risk stratification are mainly based on functional markers (creatinine and cystatin C), which are used to determine the estimated glomerular filtration rate (eGFR) and the analysis of urinary albumin excretion as a marker of kidney damage. These methods have limitations that can complicate the interpretation of the results and can lead to a delay of the diagnosis as well as to a misinterpretation of the prognosis. Therefore, new damage markers are required that sensitively and specifically detect kidney damage and enable targeted treatment. Urinalysis complements the laboratory diagnostic spectrum of diseases of the kidneys and urinary tract. It is mainly used for screening and provides important information on localization (renal/postrenal) and differentiation of kidney diseases (glomerular/tubulointerstitial).


Assuntos
Creatinina/sangue , Cistatina C/sangue , Taxa de Filtração Glomerular/fisiologia , Nefropatias/diagnóstico , Testes de Função Renal/normas , Insuficiência Renal/diagnóstico , Biomarcadores/sangue , Humanos , Rim/fisiopatologia , Nefropatias/sangue , Nefropatias/fisiopatologia , Urinálise
17.
Pediatrics ; 143(5)2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31000685

RESUMO

Capillary leak syndrome is a critical condition occasionally occurring posttransplant and is characterized by acute endothelial hyperpermeability leading to systemic protein-rich fluid extravasation and consequent hypovolemia, hypoperfusion, and acute kidney injury. Treatment is merely supportive and is based on osmotic drugs, diuretics, continuous renal replacement therapy, and surgical drainage. However, removal of the underlying inflammatory cause is mandatory to achieve stable resolution. Herein, we report the first successful treatment with colchicine in 2 life-threatening pediatric cases of capillary leak syndrome with renal failure occurring after transplant (heart and bone marrow) and unresponsive to any other line of therapy. Both cases were only palliated by supportive therapy and revealed an impressively rapid response to colchicine both in terms of diuresis and clinical condition recovery, allowing for the cessation of renal replacement therapy in a few hours. In both patients, colchicine was temporarily discontinued for transient leukopenia (attributed to an additive effect with mycophenolate mofetil), resulting in extravasation, and renal failure recurrence was restored only after colchicine reintroduction. Although the association of colchicine with an immunosuppressive drug was formerly contraindicated, no other adverse events were noted when using a minimized dose. Both patients are now maintaining a good renal function without recurrence of extravasation after 6 months of follow-up. In conclusion, this strikingly positive experience forces physicians to consider this old and cost-effective drug as a new, powerful rescue tool in such critical cases.


Assuntos
Síndrome de Vazamento Capilar/tratamento farmacológico , Colchicina/administração & dosagem , Transplante de Coração/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Insuficiência Renal/tratamento farmacológico , Moduladores de Tubulina/administração & dosagem , Adolescente , Síndrome de Vazamento Capilar/diagnóstico , Síndrome de Vazamento Capilar/etiologia , Criança , Feminino , Transplante de Coração/tendências , Transplante de Células-Tronco Hematopoéticas/tendências , Humanos , Masculino , Insuficiência Renal/diagnóstico , Insuficiência Renal/etiologia
18.
BMC Geriatr ; 19(1): 70, 2019 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-30836952

RESUMO

BACKGROUND: Numerous medications should be avoided, or require dose adjustment in subjects with impaired kidney function. We aimed to assess the prevalence of potentially inappropriate use of renal risk drugs in a nation-wide, community-dwelling Polish older adult population. METHODS: We analysed regular intake of 38 medications that should be avoided, requiring dose modification, increase the risk of pre-renal kidney injury, or may cause potassium retention in subjects with moderately to severely impaired renal function in the PolSenior data base (N = 4514, mean age 76 ± 11 yrs). Kidney function was assessed with short Modification of Diet in Renal Disease formula estimated glomerular filtration rate (sMDRD) and Cockcroft-Gault creatinine clearance (CC). RESULTS: There were 855 (19%) individuals with sMDRD < 60 ml/min/1.73m2, and 1734 (38%) with CC <  60 ml/min. Among drugs that should be avoided, spironolactone (20.4% of patients as classified by sMDRD and 17.5% by CC), non-steroidal anti-inflammatory drugs (13.4 and 11.3%), hydrochlorothiazide (11.1 and 11.0%), and metformin (6.9 and 8.2%) were most frequently used. The most frequently used drugs requiring dose modification were piracetam (13.9% by sMDRD, and 11.9% by CC), digoxin (8.3 and 8.8%), and gliclazide (6.8 and 5.9%). Classification of a drug use as 'appropriate' or 'inappropriate' was discordant depending on the method of kidney function assessment (sMDRD or CC) in up to 30%. Subgroups with sMDRD < 60 ml/min/1.73m2 and with CC <  60 ml/min were taking ≥2 drugs increasing the risk of pre-renal kidney injury more frequently than individuals with better kidney function (46.6 vs. 23.1 and 33.0% vs. 24.4%, respectively). There were 24.7% of individuals with sMDRD < 60 ml/min/1.73m2 and 18.0% with CC <  60 ml/min taking 2 or more drugs increasing serum potassium level. The proportion of subjects with hyperkalaemia increased with the number of such drugs. CONCLUSIONS: Use of drugs that should be avoided or require dose adjustment due to renal impairment, and potentially inappropriate drug combinations is a common problem in older adults in Poland. Assessment of kidney function with sMDRD may result in overlooking of requirements for dose adjustment formulated based on creatinine clearance. TRIAL REGISTRATION: Not applicable.


Assuntos
Planejamento em Saúde Comunitária/métodos , Avaliação Geriátrica , Testes de Função Renal/métodos , Insuficiência Renal/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Cálculos da Dosagem de Medicamento , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Polônia/epidemiologia , Insuficiência Renal/diagnóstico , Estudos Retrospectivos
20.
Stroke ; 50(5): 1140-1148, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30913984

RESUMO

Background and Purpose- Although rivaroxaban 15 mg (R15) was only given to patients with creatinine clearance (CrCl) ≤50 mL/min in the pivotal clinical trial, this dose has been commonly prescribed in Asian patients with nonvalvular atrial fibrillation regardless of renal function. There is a paucity of information on the clinical outcomes of R15 compared with rivaroxaban 20 mg (R20) in patients with CrCl ≥50 mL/min. This study aimed to examine the effectiveness and safety of 2 doses of rivaroxaban in Asian patients with atrial fibrillation and CrCl ≥50 mL/min. Methods- Using the Korean National Health Insurance Service database, patients with atrial fibrillation and normal or mildly impaired renal function (CrCl ≥50 mL/min) and naive to rivaroxaban or warfarin were included from January 2014 to December 2016. Three separate 1:1 propensity score-matched cohorts were conducted: R20 versus warfarin (n=15 584), R15 versus warfarin (n=11 554), and R20 versus R15 (n=10 392). Hazard ratios for ischemic stroke, intracranial hemorrhage, gastrointestinal bleeding, major bleeding, all-cause death, and composite clinical outcome were analyzed. Results- Compared with warfarin, both R20 and R15 showed significantly lower risk for ischemic stroke, major bleeding (mainly through reduction of intracranial hemorrhage), and all-cause death. Compared with R15, R20 showed better results for the composite clinical outcome (hazard ratio, 0.852; 95% CI, 0.735-0.988). This benefit was consistently observed in patients aged ≥80 years and those <50 kg. R20 was associated with higher risk of major bleeding than R15 in patients with marginal CrCl (50-60 mL/min). Conclusions- Among Asians with atrial fibrillation and CrCl ≥50 mL/min, both R20 and R15 were associated with reduced risk of ischemic stroke, intracranial hemorrhage, major bleeding, and all-cause death without significantly increased risk of gastrointestinal bleeding compared with warfarin. In patients with CrCl ≥50 mL/min, on-label R20 showed better results for the composite clinical outcome compared with off-label R15.


Assuntos
Grupo com Ancestrais do Continente Asiático , Fibrilação Atrial/tratamento farmacológico , Inibidores do Fator Xa/administração & dosagem , Insuficiência Renal/tratamento farmacológico , Rivaroxabana/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/diagnóstico , Insuficiência Renal/epidemiologia , República da Coreia/epidemiologia , Estudos Retrospectivos
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