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1.
N Engl J Med ; 383(3): 240-251, 2020 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-32668114

RESUMO

BACKGROUND: Acute kidney injury is common in critically ill patients, many of whom receive renal-replacement therapy. However, the most effective timing for the initiation of such therapy remains uncertain. METHODS: We conducted a multinational, randomized, controlled trial involving critically ill patients with severe acute kidney injury. Patients were randomly assigned to receive an accelerated strategy of renal-replacement therapy (in which therapy was initiated within 12 hours after the patient had met eligibility criteria) or a standard strategy (in which renal-replacement therapy was discouraged unless conventional indications developed or acute kidney injury persisted for >72 hours). The primary outcome was death from any cause at 90 days. RESULTS: Of the 3019 patients who had undergone randomization, 2927 (97.0%) were included in the modified intention-to-treat analysis (1465 in the accelerated-strategy group and 1462 in the standard-strategy group). Of these patients, renal-replacement therapy was performed in 1418 (96.8%) in the accelerated-strategy group and in 903 (61.8%) in the standard-strategy group. At 90 days, death had occurred in 643 patients (43.9%) in the accelerated-strategy group and in 639 (43.7%) in the standard-strategy group (relative risk, 1.00; 95% confidence interval [CI], 0.93 to 1.09; P = 0.92). Among survivors at 90 days, continued dependence on renal-replacement therapy was confirmed in 85 of 814 patients (10.4%) in the accelerated-strategy group and in 49 of 815 patients (6.0%) in the standard-strategy group (relative risk, 1.74; 95% CI, 1.24 to 2.43). Adverse events occurred in 346 of 1503 patients (23.0%) in the accelerated-strategy group and in 245 of 1489 patients (16.5%) in the standard-strategy group (P<0.001). CONCLUSIONS: Among critically ill patients with acute kidney injury, an accelerated renal-replacement strategy was not associated with a lower risk of death at 90 days than a standard strategy. (Funded by the Canadian Institutes of Health Research and others; STARRT-AKI ClinicalTrials.gov number, NCT02568722.).


Assuntos
Lesão Renal Aguda/terapia , Terapia de Substituição Renal , Lesão Renal Aguda/mortalidade , Idoso , Estado Terminal/terapia , Humanos , Análise de Intenção de Tratamento , Pessoa de Meia-Idade , Terapia de Substituição Renal/efeitos adversos , Tempo para o Tratamento , Resultado do Tratamento
2.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(6): 721-725, 2020 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-32684220

RESUMO

OBJECTIVE: To construct and evaluate a decision tree based on biomarkers for predicting severe acute kidney injury (AKI) in critical patients. METHODS: A prospectively study was conducted. Critical patients who had been admitted to the department of critical care medicine of Xiaolan Hospital of Southern Medical University from January 2017 to June 2018 were enrolled. The clinical data of the patients were recorded, and the biomarkers, including serum cystatin C (sCys C) and urinary N-acetyl-ß-D-glucosaminidase (uNAG) were established immediately after admission to intensive care unit (ICU), and the end points were recorded. The test cohort was established with patient data from January to December 2017. The decision tree classification and regression tree (CART) algorithm was used, and the best cut-off values of biomarkers were used as the decision node to construct a biomarker decision tree model for predicting severe AKI. The accuracy of the decision tree model was evaluated by the overall accuracy and the receiver operating characteristic (ROC) curve. The validation cohort, established on patient data from January to June 2018, was used to further validate the accuracy and predictive ability of the decision tree. RESULTS: In test cohort, 263 patients were enrolled, of whom 57 developed severe AKI [defined as phase 2 and 3 of Kidney Disease: Improving Global Outcomes (KDIGO) criterion]. Compared with patients without severe AKI, severe AKI patients were older [years old: 64 (49, 74) vs. 52 (41, 66)], acute physiology and chronic health evaluation II (APACHE II) score were higher [23 (19, 27) vs. 15 (11, 20)], the incidence of hypertension, diabetes and other basic diseases and sepsis were higher (64.9% vs. 40.3%, 28.1% vs. 10.7%, 63.2% vs. 29.6%), the levels of sCys C and uNAG were higher [sCys C (mg/L): 1.38 (1.12, 2.02) vs. 0.79 (0.67, 0.98), uNAG (U/mmol Cr): 5.91 (2.43, 10.68) vs. 2.72 (1.60, 3.90)], hospital mortality and 90-day mortality were higher (21.1% vs. 4.4%, 52.6% vs. 13.1%), the length of ICU stay was longer [days: 6.0 (4.0, 9.5) vs. 3.0 (1.0, 6.0)], and renal replacement therapy requirement was higher (22.8% vs. 1.9%), with statistically significant differences (all P < 0.05). ROC curve analysis showed that the areas under ROC curve (AUC) of sCys C and uNAG in predicting severe AKI were 0.857 [95% confidence interval (95%CI) was 0.809-0.897)] and 0.735 (95%CI was 0.678-0.788), and the best cut-off values were 1.05 mg/L and 5.39 U/mmol Cr, respectively. The structure of the biomarker decision tree model constructed by biomarkers were intuitive. The overall accuracy in predicting severe AKI was 86.0%, and AUC was 0.905 (95%CI was 0.863-0.937), the sensitivity was 0.912, and the specificity was 0.796. In validation cohort of 130 patients, this decision tree yielded an excellent AUC of 0.909 (95%CI was 0.846-0.952), the sensitivity was 0.906, and the specificity was 0.816, with an overall accuracy of 81.0%. CONCLUSIONS: The decision tree model based on biomarkers for predicting severe AKI in critical patients is highly accurate, intuitive and executable, which is helpful for clinical judgment and decision.


Assuntos
Lesão Renal Aguda , Estado Terminal , Biomarcadores , Árvores de Decisões , Humanos , Unidades de Terapia Intensiva , Prognóstico , Curva ROC , Terapia de Substituição Renal
3.
Zhonghua Gan Zang Bing Za Zhi ; 28(6): 532-535, 2020 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-32660187

RESUMO

Liver failure is a rapidly progressive condition with a high mortality rate. Artificial liver treatment is one of the most important treatments for liver failure. In order to ensure the smooth functioning of in vitro circulation device, anticoagulants such as heparin or low-molecular-weight heparin are often used in clinical practice. However, it induces hemorrhage, thrombocytopenia and other adverse reactions, thereby threatening the life safety of liver failure patients. Regional citrate anticoagulation does not affect the coagulation mechanism in vivo, nor does it effects platelets, so in vitro circulating anticoagulants has become the first choice anticoagulant treatment method for continuous renal replacement therapy. Combined with the current research condition at home and abroad, the research progress of the application of regional citrate anticoagulation in artificial liver to treat liver failure is discussed, covering its principle content, application status and application prospect.


Assuntos
Falência Hepática , Fígado Artificial , Lesão Renal Aguda , Anticoagulantes , Citratos , Ácido Cítrico , Heparina , Humanos , Terapia de Substituição Renal
4.
Medicine (Baltimore) ; 99(26): e20990, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590812

RESUMO

RATIONALE: Metformin-associated lactic acidosis (MALA) is rarely encountered, but has a high mortality rate, Conventional treatments include hemodialysis or continuous renal replacement therapy (CRRT); however, when the disease progresses to end-stage, cardiac function is significantly inhibited, circulation cannot be maintained, CRRT cannot be tolerated, V-A extracorporeal membrane oxygenation (ECMO) may be the last treatment. PATIENT CONCERNS: The study report a rare case of MALA in an elderly female patient at the age of 72 who was admitted to hospital because of nausea for 2 days, complicated with systemic fatigue. DIAGNOSIS: MALA was cofirmed because of patient have increased lactic acid levels, blood pH <7.2, and a history of oral metformin intake. INTERVENTIONS: Venoarterial ECMO (V-A ECMO) combined with CRRT was initiated when circulation was still not hold after intravenous fluids and 5% sodium bicarbonate were prescribed. OUTCOMES: V-A ECMO was then terminated after 48 hours when circulation was perserved, CRRT was discontinued when PH and lactic acid level were normal limited. etformin-associated lactic acidosis did not recur during 6 months follow-up. LESSONS: The incidence of MALA is low, but mortality is very high. Intermittent hemodialysis or CRRT should be performed if the lactic acid level is persistently elevated. When severe circulatory dysfunction occurs and cardiac function is inhibited, V-A ECMO support should be performed immediately to maintain circulation, followed by CRRT, which may be the final measure to treat refractory MALA.


Assuntos
Acidose Láctica/terapia , Oxigenação por Membrana Extracorpórea/métodos , Metformina/efeitos adversos , Terapia de Substituição Renal/métodos , Acidose Láctica/etiologia , Idoso , Eletrocardiografia/métodos , Feminino , Humanos , Hipoglicemiantes/efeitos adversos , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico
5.
PLoS One ; 15(6): e0235459, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32589691

RESUMO

Coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China, in December 2019. Although previous studies have described the clinical aspects of COVID-19, few studies have focused on the early detection of severe COVID-19. Therefore, this study aimed to identify the predictors of severe COVID-19 and to compare clinical features between patients with severe COVID-19 and those with less severe COVID-19. Patients admitted to designated hospital in the Henan Province of China who were either discharged or died prior to February 15, 2020 were enrolled retrospectively. Additionally, patients who underwent at least one of the following treatments were assigned to the severe group: continuous renal replacement therapy, high-flow oxygen absorption, noninvasive and invasive mechanical ventilation, or extracorporeal membrane oxygenation. The remaining patients were assigned to the non-severe group. Demographic information, initial symptoms, and first visit examination results were collected from the electronic medical records and compared between the groups. Multivariate logistic regression analysis was performed to determine the predictors of severe COVID-19. A receiver operating characteristic curve was used to identify a threshold for each predictor. Altogether,104 patients were enrolled in our study with 30 and 74 patients in the severe and non-severe groups, respectively. Multivariate logistic analysis indicated that patients aged ≥63 years (odds ratio = 41.0; 95% CI: 2.8, 592.4), with an absolute lymphocyte value of ≤1.02×109/L (odds ratio = 6.1; 95% CI = 1.5, 25.2) and a C-reactive protein level of ≥65.08mg/L (odds ratio = 8.9; 95% CI = 1.0, 74.2) were at a higher risk of severe illness. Thus, our results could be helpful in the early detection of patients at risk for severe illness, enabling the implementation of effective interventions and likely lowering the morbidity of COVID-19 patients.


Assuntos
Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Adulto , Fatores Etários , Idoso , Betacoronavirus , China , Infecções por Coronavirus/fisiopatologia , Oxigenação por Membrana Extracorpórea , Feminino , Febre/virologia , Hospitalização , Humanos , Contagem de Leucócitos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pandemias , Pneumonia Viral/fisiopatologia , Valor Preditivo dos Testes , Curva ROC , Terapia de Substituição Renal , Respiração Artificial , Estudos Retrospectivos
9.
BMJ ; 369: m1186, 2020 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-32349963

RESUMO

OBJECTIVE: To assess the association between use of sodium-glucose co-transporter 2 (SGLT2) inhibitors and risk of serious renal events in data from routine clinical practice. DESIGN: Cohort study using an active comparator, new user design and nationwide register data. SETTING: Sweden, Denmark, and Norway, 2013-18. PARTICIPANTS: Cohort of 29 887 new users of SGLT2 inhibitors (follow-up time: dapagliflozin 66.1%; empagliflozin 32.6%; canagliflozin 1.3%) and 29 887 new users of an active comparator, dipeptidyl peptidase-4 inhibitors, matched 1:1 on the basis of a propensity score with 57 variables. Mean follow-up time was 1.7 (SD 1.0) years. EXPOSURES: SGLT2 inhibitors versus dipeptidyl peptidase-4 inhibitors, defined by filled prescriptions and analysed according to intention to treat. MAIN OUTCOME MEASURES: The main outcome was serious renal events, a composite including renal replacement therapy, death from renal causes, and hospital admission for renal events. Secondary outcomes were the individual components of the main outcome. RESULTS: The mean age of the study population was 61.3 (SD 10.5) years; 11 108 (19%) had cardiovascular disease, and 1974 (3%) had chronic kidney disease. Use of SGLT2 inhibitors, compared with dipeptidyl peptidase-4 inhibitors, was associated with a reduced risk of serious renal events (2.6 events per 1000 person years versus 6.2 events per 1000 person years; hazard ratio 0.42 (95% confidence interval 0.34 to 0.53); absolute difference -3.6 (-4.4 to -2.8) events per 1000 person years). In secondary outcome analyses, the hazard ratio for use of SGLT2 inhibitors versus dipeptidyl peptidase-4 inhibitors was 0.32 (0.22 to 0.47) for renal replacement therapy, 0.41 (0.32 to 0.52) for hospital admission for renal events, and 0.77 (0.26 to 2.23) for death from renal causes. In sensitivity analyses in each of the Swedish and Danish parts of the cohort, the model was further adjusted for glycated haemoglobin and estimated glomerular filtration rate (Sweden and Denmark) and for blood pressure, body mass index, and smoking (Sweden only); in these analyses, the hazard ratio moved from 0.41 (0.26 to 0.66) to 0.50 (0.31 to 0.81) in Sweden and from 0.42 (0.32 to 0.56) to 0.55 (0.41 to 0.74) in Denmark. CONCLUSIONS: In this analysis using nationwide data from three countries, use of SGLT2 inhibitors, compared with dipeptidyl peptidase-4 inhibitors, was associated with a significantly reduced risk of serious renal events.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Nefropatias/epidemiologia , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Lesão Renal Aguda/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Compostos Benzidrílicos/uso terapêutico , Canagliflozina/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , Estudos de Coortes , Comorbidade , Dinamarca/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Glucosídeos/uso terapêutico , Hospitalização/estatística & dados numéricos , Humanos , Nefropatias/mortalidade , Nefropatias/terapia , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Modelos de Riscos Proporcionais , Insuficiência Renal Crônica/epidemiologia , Terapia de Substituição Renal/estatística & dados numéricos , Suécia/epidemiologia
10.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(3): 313-318, 2020 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-32385995

RESUMO

OBJECTIVE: To investigate the different outcomes of two types of acute kidney injury (AKI) according to standard of Kidney Disease: Improving Global Outcomes-AKI (KDIGO-AKI), and to analyze the risk factors that affect the prognosis of intensive care unit (ICU) patients in China. METHODS: A secondary analysis was performed on the database of a previous study conducted by China Critical Care Clinical Trial Group (CCCCTG), which was a multicenter prospective study involving 3 063 patients in 22 tertiary ICUs in 19 provinces and autonomous regions of China. The demographic data, scores reflecting severity of illness, laboratory findings, intervention during ICU stay were extracted. All patients were divided into pure AKI (PAKI) and acute on chronic kidney disease (AoCKD). PAKI was defined as meeting the serum creatinine (SCr) standard of KDIGO-AKI (KDIGO-AKISCr) and the estimated glomerular filtration rate (eGFR) at baseline was ≥ 60 mL×min-1×1.73 m-2, and AoCKD was defined as meeting the KDIGO-AKISCr standard and baseline eGFR was 15-59 mL×min-1×1.73 m-2. All-cause mortality in ICU within 28 days was the primary outcome, while the length of ICU stay and renal replacement therapy (RRT) were the secondary outcome. The differences in baseline data and outcomes between the two groups were compared. The cumulative survival rate of ICU within 28 days was analyzed by Kaplan-Meier survival curve, and the risk factors of ICU death within 28 days were screened by Cox multivariate analysis. RESULTS: Of the 3 063 patients, 1 042 were enrolled, 345 with AKI, 697 without AKI. The AKI incidence was 33.11%, while ICU mortality within 28 days of AKI patients was 13.91% (48/345). Compared with PAKI patients (n = 322), AoCKD patients (n = 23) were older [years old: 74 (59, 77) vs. 58 (41, 72)] and more critical when entering ICU [acute physiology and chronic health evaluation II (APACHE II) score: 23 (19, 27) vs. 15 (11, 22)], had worse basic renal function [eGFR (mL×min-1×1.73 m-2): 49 (38, 54) vs. 115 (94, 136)], more basic complications [Charlson comorbidity index (CCI): 3 (2, 4) vs. 0 (0, 1)] and higher SCr during ICU stay [peak SCr for diagnosis of AKI (µmol/L): 412 (280, 515) vs. 176 (124, 340), all P < 0.01]. The mortality and RRT incidence within 28 days in ICU of AoCKD patients were significantly higher than those of PAKI patients [39.13% (9/23) vs. 12.11% (39/322), 26.09% (6/23) vs. 4.04% (13/322), both P < 0.01], while no significant difference was found in the length of ICU stay. Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate in ICU in AoCKD patients was significantly lower than PAKI patients (Log-Rank: χ 2 = 5.939, P = 0.015). Multivariate Cox regression analysis showed that admission to ICU due to respiratory failure [hazard ratio (HR) = 4.458, 95% confidence interval (95%CI) was 1.141-17.413, P = 0.032], vasoactive agents treatment in ICU (HR = 5.181, 95%CI was 2.033-13.199, P = 0.001), and AoCKD (HR = 5.377, 95%CI was 1.303-22.186, P = 0.020) were independent risk factors for ICU death within 28 days. CONCLUSIONS: Further detailed classification (PAKI, AoCKD) based on KDIGO-AKISCr standard combined with eGFR is related to ICU mortality in critical patients within 28 days.


Assuntos
Lesão Renal Aguda/sangue , Creatinina/sangue , Adulto , China , Estado Terminal , Humanos , Unidades de Terapia Intensiva , Estudos Prospectivos , Terapia de Substituição Renal , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
11.
J Glob Antimicrob Resist ; 21: 340-341, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32353526

RESUMO

Cytokine release syndrome is prevalent in severe cases of COVID-19. In this syndrome, an uncontrolled response of immune system occurs. Extracorporeal blood purification has been proven to effectively remove the released inflammatory cytokines. Here, we reported a successful case to represent our experience of extracorporeal blood purification in a patient with severe COVID-19.


Assuntos
Infecções por Coronavirus/terapia , Hemoperfusão/métodos , Pneumonia Viral/terapia , Terapia de Substituição Renal/métodos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/virologia , Citocinas/sangue , Humanos , Interleucina-6/sangue , Irã (Geográfico) , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/virologia
13.
Nefrologia ; 40(3): 272-278, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32389518

RESUMO

INTRODUCTION: The recent appearance of the SARS-CoV-2 coronavirus pandemic has had a significant impact on the general population. Patients on renal replacement therapy (RRT) have not been unaware of this situation and due to their characteristics they are especially vulnerable. We present the results of the analysis of the COVID-19 Registry of the Spanish Society of Nephrology. MATERIAL AND METHODS: The Registry began operating on March 18th, 2020. It collects epidemiological variables, contagion and diagnosis data, signs and symptoms, treatments and outcomes. It is an online registry. Patients were diagnosed with SARS-CoV-2 infection based on the results of the PCR of the virus, carried out both in patients who had manifested compatible symptoms or had suspicious signs, as well as in those who had undergone screening after some contact acquainted with another patient. RESULTS: As of April 11, the Registry had data on 868 patients, from all the Autonomous Communities. The most represented form of RRT is in-center hemodialysis (ICH) followed by transplant patients. Symptoms are similar to the general population. A very high percentage (85%) required hospital admission, 8% in intensive care units. The most used treatments were hydroxychloroquine, lopinavir-ritonavir, and steroids. Mortality is high and reaches 23%; deceased patients were more frequently on ICH, developed pneumonia more frequently, and received less frequently lopinavir-ritonavir and steroids. Age and pneumonia were independently associated with the risk of death. CONCLUSIONS: SARS-CoV-2 infection already affects a significant number of Spanish patients on RRT, mainly those on ICH, hospitalization rates are very high and mortality is high; age and the development of pneumonia are factors associated with mortality.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Nefrologia/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Sistema de Registros/estatística & dados numéricos , Terapia de Substituição Renal/estatística & dados numéricos , Fatores Etários , Idoso , Distribuição de Qui-Quadrado , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/mortalidade , Feminino , Unidades Hospitalares de Hemodiálise/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/mortalidade , Sociedades Médicas , Espanha/epidemiologia , Estatísticas não Paramétricas , Avaliação de Sintomas/estatística & dados numéricos , Transplantados/estatística & dados numéricos
15.
Ren Fail ; 42(1): 483-488, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32438839

RESUMO

The coronavirus disease-19 (COVID-19) has spread over many countries and regions since the end of 2019, becoming the most severe public health event at present. Most of the critical cases developed multiple organ dysfunction, including acute kidney injury (AKI). Cytokine storm syndrome (CSS) may complicate the process of severe COVID-19 patients. This manuscript reviews the different aspects of blood purification in critically ill patients with AKI and increased inflammatory factors, and examines its potential role in severe COVID-19 treatment. Continuous renal replacement therapy (CRRT) has been practiced in many sepsis patients with AKI. Still, the timing and dosing need further robust evidence. In addition to the traditional CRRT, the high-throughput membrane with adsorption function and cytokine adsorption column are two representatives of recently emerging novel membrane technologies. Their potential in removing inflammatory factors and other toxins prospects for the treatment of severe COVID-19.


Assuntos
Betacoronavirus , Calcinose/terapia , Infecções por Coronavirus/terapia , Citocinas , Doenças das Valvas Cardíacas/terapia , Hipotricose/terapia , Pneumonia Viral/terapia , Terapia de Substituição Renal , Dermatopatias Genéticas/terapia , Calcinose/etiologia , Infecções por Coronavirus/complicações , Estado Terminal , Doenças das Valvas Cardíacas/etiologia , Humanos , Hipotricose/etiologia , Pandemias , Pneumonia Viral/complicações , Dermatopatias Genéticas/etiologia
17.
Artigo em Inglês | MEDLINE | ID: mdl-32280422

RESUMO

This column is supplied by Amol Patel, DO, and Peter Nguyen, MD. Dr. Patel is an internal medicine resident at Houston Methodist Hospital, where he is in his final year as chief resident. He received his bachelor's degree in biomedical engineering at Texas A&M University and his medical degree at UNT Health Science center in Forth Worth, Texas. Dr. Nguyen is a nephrologist with Houston Kidney Consultants and practices at Houston Methodist Hospital, where he is currently the secretary of the medical staff. He obtained his medical degree from Texas Tech School of Medicine and completed his residency and nephrology fellowship at Baylor College of Medicine in Houston, Texas.


Assuntos
Lesão Renal Aguda/terapia , Taxa de Filtração Glomerular , Balão Intra-Aórtico , Rim/fisiopatologia , Terapia de Substituição Renal , Choque Cardiogênico/terapia , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/fisiopatologia , Progressão da Doença , Humanos , Balão Intra-Aórtico/efeitos adversos , Balão Intra-Aórtico/instrumentação , Balão Intra-Aórtico/mortalidade , Recuperação de Função Fisiológica , Terapia de Substituição Renal/efeitos adversos , Terapia de Substituição Renal/mortalidade , Fatores de Risco , Choque Cardiogênico/complicações , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/fisiopatologia , Resultado do Tratamento
18.
Am J Respir Crit Care Med ; 201(12): 1560-1564, 2020 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-32348678
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