This document provides an overview of acute renal failure (ARF):
1) ARF remains a major therapeutic challenge and is defined as a rapid decrease in kidney function manifested by a buildup of waste products like urea and creatinine.
2) Prerenal ARF, the most common type, occurs when external factors like low blood pressure decrease blood flow to the kidneys. Parenchymal ARF results from direct kidney damage.
3) Urea, creatinine, and urine output are used to diagnose ARF despite limitations. New biomarkers show promise but require more research. Classification of ARF types is challenging without agreed standards.
1) The risk of contrast-induced acute kidney injury (CI-AKI) was assessed in a propensity score-matched cohort study.
2) The study found that use of RAAS blockade medications like ACE inhibitors and ARBs was associated with a 43% higher risk of CI-AKI.
3) Other independent risk factors for CI-AKI included chronic kidney disease, hemoglobin level <10 g/dL, albumin level <3.5 g/dL, higher contrast volume, and diuretic use.
This document discusses important considerations for drug administration in elderly patients. It notes that elderly patients often have multiple chronic conditions and take many medications. Their drug metabolism can change with age due to decreases in organ function. Specifically, absorption may decrease or increase depending on digestive changes, distribution volumes decrease for hydrophilic drugs and increase for lipophilic drugs, metabolism decreases due to liver changes, and excretion decreases due to kidney function decline. Close monitoring is needed when prescribing certain drugs that carry higher risks for adverse effects in elderly patients like benzodiazepines, digoxin, and anticoagulants. Dosage adjustment may be required based on an individual's physical characteristics.
1. Chronic kidney disease (CKD) is associated with a significantly higher risk of cardiovascular disease (CVD) mortality. CVD is the leading cause of death in CKD patients.
2. Lipid abnormalities are common in CKD and contribute to increased CVD risk. Statins are generally safe and effective for lowering lipid levels in CKD, and may help slow CKD progression as well as reduce proteinuria.
3. Other lipid lowering agents like fibrates and omega-3 fatty acids may benefit CKD patients, especially those with high triglyceride levels, but require monitoring for side effects. Multiple clinical trials are exploring optimal treatment strategies for dyslipidemia in CKD.
This document discusses renal complications associated with hematologic malignancies and their treatment. It provides 3 key points:
1) Lymphomatous infiltration of the kidneys is a common but under-recognized complication of malignant lymphomas, seen in up to one-third of patients on autopsy. Bilateral symmetrical kidney enlargement is the most common imaging finding.
2) Chemotherapies used to treat hematologic malignancies can cause acute kidney injury through tumor lysis syndrome or direct nephrotoxicity. Ifosfamide, in particular, is associated with proximal tubule dysfunction and Fanconi syndrome.
3) Long-term renal complications of chemotherapy include chronic kidney disease, which may progress even after
1) Contrast induced nephropathy (CIN) is a serious complication of cardiac procedures and can lead to acute renal failure, increased mortality, and long term renal dysfunction.
2) Many risk factors increase a patient's likelihood of developing CIN, including pre-existing renal insufficiency, diabetes, older age, hypotension, and the volume and osmolality of contrast agent used.
3) Preventive strategies aim to reduce renal ischemia and oxidative stress through hydration with intravenous fluids like sodium bicarbonate or sodium chloride, as well as pharmacological interventions including N-acetylcysteine. Larger clinical trials are still needed to determine the most effective prevention protocols.
- The document discusses contrast-induced nephropathy (CIN), including its definition, pathogenesis, incidence and risk factors, prevention methods, and recommendations.
- CIN is defined as a 25% rise in serum creatinine within 3 days of a contrast procedure. It occurs most often in patients with pre-existing renal insufficiency or diabetes and can be prevented using hydration protocols, acetylcysteine, and sodium bicarbonate administration.
- The highest risk patients include those with a baseline creatinine over 177 umol/L or over 350 umol/L. Prevention focuses on intravenous hydration, acetylcysteine, and sodium bicarbonate along with using
1) Several novel urinary biomarkers such as KIM-1, NGAL, and LFABP have been shown to be early predictors of acute kidney injury (AKI), rising in the urine within hours of injury compared to the rise in serum creatinine which occurs later.
2) Biomarkers like NGAL and KIM-1 have been shown to predict progression of AKI severity and long-term outcomes like need for renal replacement therapy and mortality.
3) Studies have demonstrated the utility of biomarkers like plasma NGAL measured at the time of clinical diagnosis of AKI after cardiac surgery to predict AKI severity and risk stratify patients for worse outcomes.
Contrast-induced nephropathy (CIN) is a type of acute kidney injury caused by iodinated contrast media used in medical imaging procedures. The document defines CIN and discusses its risk factors, pathophysiology, prevention, and management. It summarizes that CIN risk increases with reduced kidney function, diabetes, and other comorbidities. Prevention focuses on identifying at-risk patients, using lower contrast volumes and iso-osmolar agents when possible, and intravenous fluid administration before and after the procedure. Sodium bicarbonate and N-acetylcysteine may provide additional protective effects. For higher risk patients, alternative imaging should be considered to avoid CIN.
1) The risk of contrast-induced acute kidney injury (CI-AKI) was assessed in a propensity score-matched cohort study.
2) The study found that use of RAAS blockade medications like ACE inhibitors and ARBs was associated with a 43% higher risk of CI-AKI.
3) Other independent risk factors for CI-AKI included chronic kidney disease, hemoglobin level <10 g/dL, albumin level <3.5 g/dL, higher contrast volume, and diuretic use.
This document discusses important considerations for drug administration in elderly patients. It notes that elderly patients often have multiple chronic conditions and take many medications. Their drug metabolism can change with age due to decreases in organ function. Specifically, absorption may decrease or increase depending on digestive changes, distribution volumes decrease for hydrophilic drugs and increase for lipophilic drugs, metabolism decreases due to liver changes, and excretion decreases due to kidney function decline. Close monitoring is needed when prescribing certain drugs that carry higher risks for adverse effects in elderly patients like benzodiazepines, digoxin, and anticoagulants. Dosage adjustment may be required based on an individual's physical characteristics.
1. Chronic kidney disease (CKD) is associated with a significantly higher risk of cardiovascular disease (CVD) mortality. CVD is the leading cause of death in CKD patients.
2. Lipid abnormalities are common in CKD and contribute to increased CVD risk. Statins are generally safe and effective for lowering lipid levels in CKD, and may help slow CKD progression as well as reduce proteinuria.
3. Other lipid lowering agents like fibrates and omega-3 fatty acids may benefit CKD patients, especially those with high triglyceride levels, but require monitoring for side effects. Multiple clinical trials are exploring optimal treatment strategies for dyslipidemia in CKD.
This document discusses renal complications associated with hematologic malignancies and their treatment. It provides 3 key points:
1) Lymphomatous infiltration of the kidneys is a common but under-recognized complication of malignant lymphomas, seen in up to one-third of patients on autopsy. Bilateral symmetrical kidney enlargement is the most common imaging finding.
2) Chemotherapies used to treat hematologic malignancies can cause acute kidney injury through tumor lysis syndrome or direct nephrotoxicity. Ifosfamide, in particular, is associated with proximal tubule dysfunction and Fanconi syndrome.
3) Long-term renal complications of chemotherapy include chronic kidney disease, which may progress even after
1) Contrast induced nephropathy (CIN) is a serious complication of cardiac procedures and can lead to acute renal failure, increased mortality, and long term renal dysfunction.
2) Many risk factors increase a patient's likelihood of developing CIN, including pre-existing renal insufficiency, diabetes, older age, hypotension, and the volume and osmolality of contrast agent used.
3) Preventive strategies aim to reduce renal ischemia and oxidative stress through hydration with intravenous fluids like sodium bicarbonate or sodium chloride, as well as pharmacological interventions including N-acetylcysteine. Larger clinical trials are still needed to determine the most effective prevention protocols.
- The document discusses contrast-induced nephropathy (CIN), including its definition, pathogenesis, incidence and risk factors, prevention methods, and recommendations.
- CIN is defined as a 25% rise in serum creatinine within 3 days of a contrast procedure. It occurs most often in patients with pre-existing renal insufficiency or diabetes and can be prevented using hydration protocols, acetylcysteine, and sodium bicarbonate administration.
- The highest risk patients include those with a baseline creatinine over 177 umol/L or over 350 umol/L. Prevention focuses on intravenous hydration, acetylcysteine, and sodium bicarbonate along with using
1) Several novel urinary biomarkers such as KIM-1, NGAL, and LFABP have been shown to be early predictors of acute kidney injury (AKI), rising in the urine within hours of injury compared to the rise in serum creatinine which occurs later.
2) Biomarkers like NGAL and KIM-1 have been shown to predict progression of AKI severity and long-term outcomes like need for renal replacement therapy and mortality.
3) Studies have demonstrated the utility of biomarkers like plasma NGAL measured at the time of clinical diagnosis of AKI after cardiac surgery to predict AKI severity and risk stratify patients for worse outcomes.
Contrast-induced nephropathy (CIN) is a type of acute kidney injury caused by iodinated contrast media used in medical imaging procedures. The document defines CIN and discusses its risk factors, pathophysiology, prevention, and management. It summarizes that CIN risk increases with reduced kidney function, diabetes, and other comorbidities. Prevention focuses on identifying at-risk patients, using lower contrast volumes and iso-osmolar agents when possible, and intravenous fluid administration before and after the procedure. Sodium bicarbonate and N-acetylcysteine may provide additional protective effects. For higher risk patients, alternative imaging should be considered to avoid CIN.
This document discusses the prevention of venous thromboembolism (VTE) in hospitalized patients. It notes that while prevention is not necessary for all patients, those at high risk include patients undergoing surgery, those with cancer or trauma, patients in the ICU or with spinal cord injuries. Studies show medical patients have a 10-20% risk of DVT, while risks are higher, 40-80%, for other groups like trauma or arthroplasty patients. Meta-analyses found anticoagulants reduced PE, fatal PE, symptomatic DVT and overall VTE compared to placebo, without increasing major bleeding risk. For stroke patients, benefits were smaller due to many asymptomatic VTE cases, so number needed to treat was higher
The document discusses intrapericardial drug delivery as a potential method for local pancoronary therapy of vulnerable plaque. It provides evidence that the pericardial space allows for localized high concentrations of therapeutic agents with limited systemic absorption. Studies demonstrate delayed clearance and uniform distribution of agents in the pericardial space. Research suggests intrapericardial delivery may effectively modulate coronary response to injury, inhibit restenosis, and stabilize vulnerable plaque. Challenges include determining optimal agents and delivery methods, assessing repeated dosing needs, and tissue penetrability.
1. Radiocontrast agents, also known as contrast media, are substances used to improve the visibility of internal organs and structures during medical imaging. The most common types are iodine-based agents used for computed tomography and angiography, and gadolinium-based agents used for magnetic resonance imaging.
2. Contrast-induced nephropathy (CIN) refers to acute kidney injury caused by radiocontrast agents in patients with underlying renal impairment or risk factors. Preventing CIN involves identifying at-risk patients, minimizing contrast volume, using iso-osmolar or low-osmolar agents, intravenous hydration before and after exposure, and holding nephrotoxic drugs like metformin.
3
- Acute Kidney Injury (AKI) is defined as an abrupt loss of kidney function, resulting in the retention of waste products and dysregulation of fluids and electrolytes.
- Definitions and criteria for AKI have evolved over time from RIFLE to AKIN to KDIGO, focusing on increases in creatinine and decreases in urine output.
- AKI has many causes including decreased blood flow, nephrotoxins, and inflammation. It is associated with increased mortality, costs, and long term kidney problems in survivors. Early identification and preventive measures are important.
Research proposal &administration issuesFarragBahbah
This study aims to evaluate the long-term effects of parathyroidectomy (PTX) on bone histology, coronary artery calcification, and other biomarkers in hemodialysis patients with severe secondary hyperparathyroidism. A prospective observational study will follow 50 patients undergoing PTX for 12 months, assessing bone biopsies, calcium scoring via CT, and serum biomarkers at baseline and 12 months. The study hypothesizes that PTX will improve bone turnover and mineralization while reducing vascular calcification, aiming to provide insights into long-term PTX outcomes in this patient population.
The document discusses biomarkers for detecting acute kidney injury (AKI). It notes that serum creatinine is currently used but is not an early indicator. Newer biomarkers like NGAL can detect AKI earlier, within 2 hours after an event instead of 1-2 days with creatinine. Having early biomarkers could allow for improved understanding, earlier treatment and better outcomes for AKI patients. The document reviews studies on NGAL for detecting AKI in settings like cardiac surgery, contrast-induced nephropathy, sepsis, and kidney transplantation.
Imaging in Acute Kidney Injury, how not to harm patientsJoel Topf
This document summarizes evidence on the use of imaging and dialysis techniques to minimize harm in patients with acute kidney injury. It finds that while hemodialysis is generally not effective at protecting the kidneys from contrast-induced nephrotoxicity, it may be beneficial in patients with the most severe kidney impairment. Preemptive hemofiltration initiated before and continued after contrast exposure is the most effective strategy shown in randomized trials to reduce the risk of nephrotoxicity and associated outcomes like need for dialysis and mortality. However, risk also depends on the specific gadolinium-based contrast agent used, with agents having higher stability and weaker binding to gadolinium posing lower risks like nephrogenic
Diagnosis, Evaluation, Prevention and Treatment of CKD-MBDAbdullah Ansari
Introduction and definition of CKD–MBD
Diagnosis of CKD–MBD: biochemical abnormalities
Diagnosis of CKD–MBD: bone
Diagnosis of CKD–MBD: vascular calcification
Treatment of CKD–MBD targeted at serum phosphorus and serum calcium
Treatment of abnormal PTH levels in CKD–MBD
Treatment of bone with bisphosphonates, other osteoporosis medications and growth hormone
Evaluation and treatment of kidney transplant bone disease
Crizotinib is a c-MET inhibitor that has demonstrated potent inhibitory activity against ALK fusion cells. The document discusses clinical trials of crizotinib in patients with ALK-positive non-small cell lung cancer (NSCLC). Results from Phase I and II trials showed an objective response rate of 57% and disease control rate of 87% with crizotinib. Current ongoing trials are evaluating crizotinib versus chemotherapy as first-line or second-line treatment in ALK-positive NSCLC.
Sperm DNA Fragmentation in Male InfertilitySandro Esteves
This document summarizes a presentation on sperm DNA fragmentation (SDF) and male infertility. It discusses how SDF provides different information than routine semen analysis and is a better prognostic indicator. Elevated SDF is associated with infertility, poor assisted reproductive technology outcomes, and miscarriage. Several methods can assess SDF but differ in their ability to directly or indirectly measure damage. Lifestyle changes like reducing stress and smoking, treating underlying conditions, and using oral antioxidants can help lower SDF. Varicocele repair is also effective at reducing SDF levels in men with the condition.
The EVOLVE trial studied the effect of cinacalcet on cardiovascular disease in patients undergoing dialysis. The randomized controlled trial compared cinacalcet to placebo in 3,883 adults on dialysis to evaluate the primary composite endpoint of time to death or first nonfatal cardiovascular event. Secondary endpoints included time to individual components of the primary endpoint like myocardial infarction or fracture, as well as death from cardiovascular causes. The trial was designed to test the hypothesis that cinacalcet treatment might reduce mortality and cardiovascular risks by decreasing levels of phosphorus, PTH, and calcium phosphorus product known to be associated with higher mortality in dialysis patients.
Contrast-induced nephropathy (CIN) is a reversible form of acute kidney injury caused by radiocontrast media. The document discusses risk factors, pathogenesis, incidence, clinical manifestations, definitions, and preventative measures for CIN. Prevention focuses on hydration, using iso-osmolar contrast, limiting contrast volume, and identifying/treating risk factors like chronic kidney disease. Acetylcysteine and saline hydration may help reduce CIN risk but evidence for other interventions is limited.
1) Coronary artery calcification is significant and progressive in a majority of patients with early chronic kidney disease. There is an association between arterial calcification and increased risk of all-cause mortality in chronic kidney disease patients on dialysis.
2) While the data are not entirely consistent, some studies have found relatively less progression of vascular calcification with sevelamer versus calcium-containing phosphate binders among patients with chronic kidney disease.
3) One randomized controlled trial found that among hemodialysis patients treated with either calcium acetate or sevelamer for 1 year, there was similar progression of coronary artery calcification with intensive lowering of LDL-C levels in both groups.
A nuclear magnetic resonance-based method for accurate assessment of glomerul...ChristianeProllMBA
An oral presentation held by numares at the ASN KidneyWeek 2018 about a new method of GFR testing to assess kidney function using metabolic constellations and NMR diagnostics.
This document discusses contrast-induced nephropathy (CIN). It describes the types of contrast agents used, risk factors for CIN, methods for prevention including volume expansion with intravenous or oral hydration, and diagnostic criteria for CIN. The nephrotoxic effects of contrast agents increase with higher osmolality, larger volume, repeated or intra-arterial administration, and can be prevented through adequate hydration before and after exposure.
This document summarizes interim analysis results from a randomized phase 3 study of abiraterone acetate plus prednisone versus placebo plus prednisone in chemotherapy-naïve patients with metastatic castration-resistant prostate cancer. The study showed a statistically significant improvement in radiographic progression-free survival with a median of not reached for abiraterone acetate versus 8.3 months for placebo. There was also a strong trend towards improved overall survival with a median of not reached for abiraterone acetate versus 27.2 months for placebo and a 25% reduction in risk of death. Benefits were seen across patient subgroups.
This document provides an overview of acute kidney injury (AKI), including its definition, prevalence, diagnosis, pathophysiology, biomarkers, and staging criteria according to RIFLE, AKIN, and KDIGO. It discusses the need for biomarkers to detect AKI early before increases in serum creatinine. Commonly used biomarkers mentioned include neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid-binding protein (L-FABP), interleukin-18 (IL-18), and cystatin C. The pathophysiology of AKI involves alterations in renal perfusion, tubular dysfunction and cell death, intrat
This document provides an overview of intensive care nephrology, including acute kidney injury (AKI), indications for acute dialysis, complications of dialysis, and management of certain drug overdoses. It defines AKI as an acute decrease in glomerular filtration rate (GFR) and loss of small solute clearance. Staging criteria for AKI like RIFLE are discussed. Biomarkers for early detection of AKI like neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C are presented. Indications for renal replacement therapy in AKI, management of hyperkalemia, and use of bicarbonate, insulin, and salbutamol for hyperkal
This document discusses glomerular filtration rate (GFR) and factors that influence it. It provides details on:
- How GFR is determined by glomerular capillary hydrostatic and oncotic pressures.
- Average GFR in humans is 125 mL/min but can be influenced by transglomerular pressure, renal plasma flow, glomerular permeability, and oncotic pressure.
- GFR is maintained relatively constant through autoregulation and tubuloglomerular feedback mechanisms.
- Clinical assessment of GFR can be done by measuring clearance of substances like inulin, radiolabeled compounds, or creatinine. Estimated GFR formulas like Cockcroft-
This document provides the definition and classification of acute kidney injury (AKI) put forth by the Kidney Disease: Improving Global Outcomes (KIDGO) group. It defines AKI as an abrupt reduction in kidney function seen within 48 hours that can be identified by an increase in serum creatinine of 0.3 mg/dL or 1.5 times the baseline level. AKI is classified into 3 stages based on the degree of increase in serum creatinine and reduction in urine output. The definition aims to provide a standardized criteria for diagnosing and classifying AKI severity in both clinical practice and research.
This document discusses the prevention of venous thromboembolism (VTE) in hospitalized patients. It notes that while prevention is not necessary for all patients, those at high risk include patients undergoing surgery, those with cancer or trauma, patients in the ICU or with spinal cord injuries. Studies show medical patients have a 10-20% risk of DVT, while risks are higher, 40-80%, for other groups like trauma or arthroplasty patients. Meta-analyses found anticoagulants reduced PE, fatal PE, symptomatic DVT and overall VTE compared to placebo, without increasing major bleeding risk. For stroke patients, benefits were smaller due to many asymptomatic VTE cases, so number needed to treat was higher
The document discusses intrapericardial drug delivery as a potential method for local pancoronary therapy of vulnerable plaque. It provides evidence that the pericardial space allows for localized high concentrations of therapeutic agents with limited systemic absorption. Studies demonstrate delayed clearance and uniform distribution of agents in the pericardial space. Research suggests intrapericardial delivery may effectively modulate coronary response to injury, inhibit restenosis, and stabilize vulnerable plaque. Challenges include determining optimal agents and delivery methods, assessing repeated dosing needs, and tissue penetrability.
1. Radiocontrast agents, also known as contrast media, are substances used to improve the visibility of internal organs and structures during medical imaging. The most common types are iodine-based agents used for computed tomography and angiography, and gadolinium-based agents used for magnetic resonance imaging.
2. Contrast-induced nephropathy (CIN) refers to acute kidney injury caused by radiocontrast agents in patients with underlying renal impairment or risk factors. Preventing CIN involves identifying at-risk patients, minimizing contrast volume, using iso-osmolar or low-osmolar agents, intravenous hydration before and after exposure, and holding nephrotoxic drugs like metformin.
3
- Acute Kidney Injury (AKI) is defined as an abrupt loss of kidney function, resulting in the retention of waste products and dysregulation of fluids and electrolytes.
- Definitions and criteria for AKI have evolved over time from RIFLE to AKIN to KDIGO, focusing on increases in creatinine and decreases in urine output.
- AKI has many causes including decreased blood flow, nephrotoxins, and inflammation. It is associated with increased mortality, costs, and long term kidney problems in survivors. Early identification and preventive measures are important.
Research proposal &administration issuesFarragBahbah
This study aims to evaluate the long-term effects of parathyroidectomy (PTX) on bone histology, coronary artery calcification, and other biomarkers in hemodialysis patients with severe secondary hyperparathyroidism. A prospective observational study will follow 50 patients undergoing PTX for 12 months, assessing bone biopsies, calcium scoring via CT, and serum biomarkers at baseline and 12 months. The study hypothesizes that PTX will improve bone turnover and mineralization while reducing vascular calcification, aiming to provide insights into long-term PTX outcomes in this patient population.
The document discusses biomarkers for detecting acute kidney injury (AKI). It notes that serum creatinine is currently used but is not an early indicator. Newer biomarkers like NGAL can detect AKI earlier, within 2 hours after an event instead of 1-2 days with creatinine. Having early biomarkers could allow for improved understanding, earlier treatment and better outcomes for AKI patients. The document reviews studies on NGAL for detecting AKI in settings like cardiac surgery, contrast-induced nephropathy, sepsis, and kidney transplantation.
Imaging in Acute Kidney Injury, how not to harm patientsJoel Topf
This document summarizes evidence on the use of imaging and dialysis techniques to minimize harm in patients with acute kidney injury. It finds that while hemodialysis is generally not effective at protecting the kidneys from contrast-induced nephrotoxicity, it may be beneficial in patients with the most severe kidney impairment. Preemptive hemofiltration initiated before and continued after contrast exposure is the most effective strategy shown in randomized trials to reduce the risk of nephrotoxicity and associated outcomes like need for dialysis and mortality. However, risk also depends on the specific gadolinium-based contrast agent used, with agents having higher stability and weaker binding to gadolinium posing lower risks like nephrogenic
Diagnosis, Evaluation, Prevention and Treatment of CKD-MBDAbdullah Ansari
Introduction and definition of CKD–MBD
Diagnosis of CKD–MBD: biochemical abnormalities
Diagnosis of CKD–MBD: bone
Diagnosis of CKD–MBD: vascular calcification
Treatment of CKD–MBD targeted at serum phosphorus and serum calcium
Treatment of abnormal PTH levels in CKD–MBD
Treatment of bone with bisphosphonates, other osteoporosis medications and growth hormone
Evaluation and treatment of kidney transplant bone disease
Crizotinib is a c-MET inhibitor that has demonstrated potent inhibitory activity against ALK fusion cells. The document discusses clinical trials of crizotinib in patients with ALK-positive non-small cell lung cancer (NSCLC). Results from Phase I and II trials showed an objective response rate of 57% and disease control rate of 87% with crizotinib. Current ongoing trials are evaluating crizotinib versus chemotherapy as first-line or second-line treatment in ALK-positive NSCLC.
Sperm DNA Fragmentation in Male InfertilitySandro Esteves
This document summarizes a presentation on sperm DNA fragmentation (SDF) and male infertility. It discusses how SDF provides different information than routine semen analysis and is a better prognostic indicator. Elevated SDF is associated with infertility, poor assisted reproductive technology outcomes, and miscarriage. Several methods can assess SDF but differ in their ability to directly or indirectly measure damage. Lifestyle changes like reducing stress and smoking, treating underlying conditions, and using oral antioxidants can help lower SDF. Varicocele repair is also effective at reducing SDF levels in men with the condition.
The EVOLVE trial studied the effect of cinacalcet on cardiovascular disease in patients undergoing dialysis. The randomized controlled trial compared cinacalcet to placebo in 3,883 adults on dialysis to evaluate the primary composite endpoint of time to death or first nonfatal cardiovascular event. Secondary endpoints included time to individual components of the primary endpoint like myocardial infarction or fracture, as well as death from cardiovascular causes. The trial was designed to test the hypothesis that cinacalcet treatment might reduce mortality and cardiovascular risks by decreasing levels of phosphorus, PTH, and calcium phosphorus product known to be associated with higher mortality in dialysis patients.
Contrast-induced nephropathy (CIN) is a reversible form of acute kidney injury caused by radiocontrast media. The document discusses risk factors, pathogenesis, incidence, clinical manifestations, definitions, and preventative measures for CIN. Prevention focuses on hydration, using iso-osmolar contrast, limiting contrast volume, and identifying/treating risk factors like chronic kidney disease. Acetylcysteine and saline hydration may help reduce CIN risk but evidence for other interventions is limited.
1) Coronary artery calcification is significant and progressive in a majority of patients with early chronic kidney disease. There is an association between arterial calcification and increased risk of all-cause mortality in chronic kidney disease patients on dialysis.
2) While the data are not entirely consistent, some studies have found relatively less progression of vascular calcification with sevelamer versus calcium-containing phosphate binders among patients with chronic kidney disease.
3) One randomized controlled trial found that among hemodialysis patients treated with either calcium acetate or sevelamer for 1 year, there was similar progression of coronary artery calcification with intensive lowering of LDL-C levels in both groups.
A nuclear magnetic resonance-based method for accurate assessment of glomerul...ChristianeProllMBA
An oral presentation held by numares at the ASN KidneyWeek 2018 about a new method of GFR testing to assess kidney function using metabolic constellations and NMR diagnostics.
This document discusses contrast-induced nephropathy (CIN). It describes the types of contrast agents used, risk factors for CIN, methods for prevention including volume expansion with intravenous or oral hydration, and diagnostic criteria for CIN. The nephrotoxic effects of contrast agents increase with higher osmolality, larger volume, repeated or intra-arterial administration, and can be prevented through adequate hydration before and after exposure.
This document summarizes interim analysis results from a randomized phase 3 study of abiraterone acetate plus prednisone versus placebo plus prednisone in chemotherapy-naïve patients with metastatic castration-resistant prostate cancer. The study showed a statistically significant improvement in radiographic progression-free survival with a median of not reached for abiraterone acetate versus 8.3 months for placebo. There was also a strong trend towards improved overall survival with a median of not reached for abiraterone acetate versus 27.2 months for placebo and a 25% reduction in risk of death. Benefits were seen across patient subgroups.
This document provides an overview of acute kidney injury (AKI), including its definition, prevalence, diagnosis, pathophysiology, biomarkers, and staging criteria according to RIFLE, AKIN, and KDIGO. It discusses the need for biomarkers to detect AKI early before increases in serum creatinine. Commonly used biomarkers mentioned include neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid-binding protein (L-FABP), interleukin-18 (IL-18), and cystatin C. The pathophysiology of AKI involves alterations in renal perfusion, tubular dysfunction and cell death, intrat
This document provides an overview of intensive care nephrology, including acute kidney injury (AKI), indications for acute dialysis, complications of dialysis, and management of certain drug overdoses. It defines AKI as an acute decrease in glomerular filtration rate (GFR) and loss of small solute clearance. Staging criteria for AKI like RIFLE are discussed. Biomarkers for early detection of AKI like neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C are presented. Indications for renal replacement therapy in AKI, management of hyperkalemia, and use of bicarbonate, insulin, and salbutamol for hyperkal
This document discusses glomerular filtration rate (GFR) and factors that influence it. It provides details on:
- How GFR is determined by glomerular capillary hydrostatic and oncotic pressures.
- Average GFR in humans is 125 mL/min but can be influenced by transglomerular pressure, renal plasma flow, glomerular permeability, and oncotic pressure.
- GFR is maintained relatively constant through autoregulation and tubuloglomerular feedback mechanisms.
- Clinical assessment of GFR can be done by measuring clearance of substances like inulin, radiolabeled compounds, or creatinine. Estimated GFR formulas like Cockcroft-
This document provides the definition and classification of acute kidney injury (AKI) put forth by the Kidney Disease: Improving Global Outcomes (KIDGO) group. It defines AKI as an abrupt reduction in kidney function seen within 48 hours that can be identified by an increase in serum creatinine of 0.3 mg/dL or 1.5 times the baseline level. AKI is classified into 3 stages based on the degree of increase in serum creatinine and reduction in urine output. The definition aims to provide a standardized criteria for diagnosing and classifying AKI severity in both clinical practice and research.
This document provides the definition and classification of acute kidney injury (AKI) put forth by the Kidney Disease: Improving Global Outcomes (KIDGO) group. It defines AKI as an abrupt reduction in kidney function seen within 48 hours that can be identified by an increase in serum creatinine of 0.3 mg/dL or 1.5 times the baseline level. AKI is classified into 3 stages based on the level of increase in serum creatinine and the urine output amount. The definition and staging criteria aim to provide a standardized approach for identifying and classifying AKI severity in clinical practice, research, and public health monitoring.
Pitfalls in estimating renal failure in the elderly by eGFRRanjit Singh
The document discusses methods of estimating glomerular filtration rate (GFR) including direct and indirect assessments. Direct assessments involve clearance tests using exogenous or endogenous substances like inulin, iohexol, creatinine, and cystatin C. Indirect assessments utilize estimating equations like Cockcroft-Gault, MDRD, and CKD-EPI which take factors like age, sex, and creatinine levels into account. The CKD-EPI equation is currently recommended for GFR estimation in adults. Age-related declines in GFR are also discussed.
1) A study examined the relationship between renal oxygen supply and demand in patients with and without acute kidney injury (AKI) after cardiac surgery.
2) The study found that patients with AKI had a higher slope in the relationship between renal oxygen consumption and glomerular filtration rate compared to controls, indicating impaired oxygen supply relative to demand.
3) This challenges the previous view that acute renal failure represents an "acute renal success" by reducing renal workload and preserving oxygen supply, and suggests AKI may actually involve renal hypoxic injury due to inadequate oxygen supply relative to demand.
This document discusses diuretics and their use in acute kidney injury (AKI). It begins with definitions of AKI and how it is measured. AKI, formerly called acute renal failure, is a clinical syndrome involving a decline in glomerular filtration rate and the accumulation of waste products. Measurement of renal function typically involves serum creatinine, though it has limitations.
The document then discusses the epidemiology of AKI, noting it occurs in 1-7% of hospitalized patients and carries high mortality, especially those requiring renal replacement therapy. High risk factors for AKI are discussed.
The bulk of the document focuses on diuretics - their definitions, classes including loop diuretics and mechanisms of
This document discusses acute kidney injury (AKI). It provides definitions of AKI from various clinical practice guidelines. AKI can be prerenal, intrinsic, or postrenal based on its etiology. Common causes are listed. Diagnosis involves medical history, physical exam, lab tests of blood and urine. Staging systems like RIFLE and KDIGO use changes in serum creatinine and urine output to stage AKI severity. Prevention focuses on identifying at-risk patients and implementing strategies like intravenous fluids. Treatment aims to support kidney function through fluid management, electrolyte monitoring, and potentially renal replacement therapy like hemodialysis.
Dr. Manan B. Shah presented on biomarkers for acute kidney injury. The presentation discussed the need for biomarkers to detect AKI earlier than serum creatinine, as creatinine levels typically rise only after 50% kidney function is lost. Several promising urinary biomarkers were described, including NGAL, KIM-1, IL-18, and cystatin C, which can indicate kidney injury earlier. The presentation proposed that a panel of biomarkers may help guide whether renal replacement therapy is needed for patients with AKI. Early detection and treatment of AKI using biomarkers could potentially improve outcomes by preventing or minimizing kidney injury.
This document provides an overview of acute kidney injury (AKI), including its classification, epidemiology, etiology, pathophysiology, patient assessment, and clinical presentation. It discusses the RIFLE, AKIN, and KDIGO classification systems for AKI and covers the major causes and mechanisms of pre-renal, intrinsic, and post-renal AKI. Patient assessment involves reviewing the medical history, medications, physical exam, and distinguishing signs of AKI from chronic kidney disease. Changes in urinary output can help indicate the underlying cause of AKI in hospitalized patients.
Anemia Indian scenario In Chronic Kidney Disease Patients Dr Ashutosh Ojha
this is a comprehensive presentation in Post Doctoral Certificate in Nephrology training program. At Gauhati Medical College Hospital ,Dept Of Nephrology.
This document summarizes results from the AURA-LV clinical trial studying the efficacy and safety of voclosporin in treating lupus nephritis. The trial found that patients receiving 23.7 mg of voclosporin twice daily were over twice as likely to achieve complete renal remission at 24 weeks compared to the placebo group. They were also more likely to achieve partial remission and saw faster time to response. At 48 weeks, the low-dose voclosporin group maintained higher remission rates and saw continued improvement in proteinuria levels over time, demonstrating voclosporin's potential as a new treatment for lupus nephritis.
This document summarizes current treatment guidelines for lupus nephritis. It defines lupus nephritis based on ACR criteria and recommends an early renal biopsy. For initial treatment of proliferative lupus nephritis (classes III/IV), guidelines differ on whether cyclophosphamide or mycophenolate mofetil is preferred. Maintenance therapy with mycophenolate mofetil or azathioprine with low-dose steroids is recommended, with mycophenolate mofetil showing better outcomes. Immunosuppression should be continued for at least one year after complete remission is achieved.
1. The publication of new UK guidelines for Chronic Kidney Disease in 2005 led to changes in how renal impairment is classified and estimated glomerular filtration rate (eGFR) is now routinely reported.
2. While eGFR provides a quick assessment of kidney function, it should not be used to calculate drug dosages because it is standardized to a body surface area of 1.73m2 and can over or under estimate renal function in individuals.
3. The Cockcroft-Gault equation, which estimates creatinine clearance based on creatinine levels, age, gender and weight, is preferable for calculating drug dosages in patients with renal impairment.
This document discusses the management of acute kidney injury (AKI). It defines AKI and outlines its diagnosis and evaluation. AKI is common in hospitalized patients and associated with increased short- and long-term mortality. When present, determining the underlying cause is important as some causes are reversible. Prevention focuses on optimizing volume status and avoiding nephrotoxic drugs. Currently there are no approved pharmacotherapies for treating AKI, and the optimal timing of renal replacement therapy is unclear. Recent evidence suggests AKI increases risk for chronic kidney disease and future kidney injury.
This document provides an overview of acute kidney injury (AKI) management. It discusses that AKI is common in hospitalized patients and associated with increased morbidity and mortality. When AKI is present, the underlying cause should be promptly investigated, with attention to potentially reversible causes. Measures to prevent AKI include optimizing volume status and avoiding nephrotoxic medications. Currently there are no approved targeted pharmacotherapies for treating AKI, and the optimal timing of renal replacement therapy is unclear.
Prof. a. el sebaeii.fluid management in patients with akiwessam1071
Acute renal failure (ARF) is common in intensive care units (ICUs) and is associated with high mortality. Early fluid management is important to prevent and treat ARF. While aggressive hydration and maintaining adequate blood pressure can help prevent ARF, both overhydration and underhydration should be avoided as they can worsen renal function. No intravenous fluid is ideal, and fluid choice and management should be tailored to the individual patient based on their fluid status and needs. Early initiation of renal replacement therapy should be considered for patients with complications from ARF such as fluid overload or electrolyte abnormalities.
This document discusses definitions, classifications, and clinical applications of acute kidney injury (AKI) according to KDIGO guidelines from 2012. It defines AKI as an increase in serum creatinine of ≥0.3 mg/dL within 48 hours or an increase to ≥1.5 times baseline within 7 days. AKI is staged from 1 to 3 based on increases in creatinine from baseline or reductions in urine output. Proper estimation of baseline creatinine and clinical judgment are important for accurate diagnosis and staging. Pseudo-AKI and atypical cases may not meet diagnostic criteria but still represent kidney injury.
This document discusses antibiotic dosing during renal failure. It explains the importance of dose adjustments with renal impairment due to decreased drug elimination. It compares methods to calculate glomerular filtration rate (GFR) and creatinine clearance, such as the Modification of Diet in Renal Disease (MDRD) and Cockroft-Gault equations. It also describes different types of dialysis and considerations for dosing antibiotics in patients receiving dialysis or continuous renal replacement therapy.
Acs0522 procedures for benign and malignant biliary tract disease-2005medbookonline
This document discusses procedures for benign and malignant biliary tract diseases. It provides guidance on preoperative evaluation and management of biliary obstruction. Specific considerations are given to infection, renal dysfunction, impaired immunity, malnutrition, and coagulation issues. The document outlines operative planning details such as patient positioning, exposure techniques, and guidelines for biliary anastomoses including suture placement and techniques for difficult access situations.
This document discusses the anatomy and surgical procedure of splenectomy. It describes:
- The spleen's highly variable arterial blood supply, which can take bundled or distributed patterns. This variability impacts the difficulty of surgery.
- The splenic artery typically branches off the celiac axis but can originate from other nearby arteries in rare cases.
- Additional branches of the splenic artery before it enters the spleen, including short gastric and pancreatic arteries.
- A history of splenectomy beginning in the 16th century and its increasing use through the 20th century for trauma and hematologic disorders.
- The development of laparoscopic splenectomy in the early 1990s and ongoing refinement of minim
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to the skin. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and attached to form a mucosal lined tube to prevent regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach heals and functions return to normal.
This document describes the Billroth I gastric resection procedure, which involves removing part of the stomach and reattaching it to the duodenum. Key steps include transecting the stomach, attaching it to the duodenum using a circular stapler, and closing the gastrotomy site. The procedure aims to control peptic ulcers by combining hemigastrectomy with vagotomy while restoring normal gastrointestinal continuity. Postoperative care focuses on gradual advancement of oral intake and monitoring for complications.
This document describes the Billroth I procedure for gastroduodenostomy. It involves extensive mobilization of the stomach and duodenum to allow for an end-to-end anastomosis between the stomach and duodenum, restoring normal continuity of the gastrointestinal tract. The stomach is divided and sutured closed, then sutured to the duodenum in layers to create the gastroduodenal connection. Postoperative care focuses on gradual advancement of diet and monitoring for gastric retention to support healing and prevent complications.
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to prevent leakage. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and lined with mucosa to form a permanent opening, preventing regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach and bowel recover function.
Gastrojejunostomy is a surgical procedure that connects the stomach directly to the jejunum. It is indicated for patients with duodenal ulcers complicated by pyloric obstruction or nonresectable stomach or pancreatic cancers causing obstruction. The procedure involves opening the stomach and jejunum, suturing them together to form a stoma, then closing in multiple layers. Postoperatively, gastric emptying is monitored and diet advanced gradually to ensure proper healing.
This document provides guidance on treating a perforated ulcer or subphrenic abscess. It describes:
1) Preparing patients preoperatively by administering IV fluids/antibiotics and gastric suction.
2) Closing perforations by suturing the ulcer and reinforcing it with omentum, or sealing it if too indurated.
3) Draining subphrenic abscesses extraperitoneally by making incisions below the costal margin or through the 12th rib bed and inserting drains into the abscess cavity.
A C S0103 Perioperative Considerations For Anesthesiamedbookonline
This document discusses perioperative considerations for anesthesia. It notes advancements in modern surgical care and alterations in anesthetic management to maximize patient benefit. A preoperative evaluation is important to assess medical history and current medications. Certain medications may need to be adjusted or discontinued before surgery, such as MAOIs, oral anticoagulants, and some herbal supplements, to reduce risks of adverse reactions or bleeding complications during the procedure. The risks and options for anesthesia should be discussed with the patient.
A C S0105 Postoperative Management Of The Hospitalized Patientmedbookonline
This document discusses postoperative management of surgical patients. It describes the different levels of postoperative care including same-day surgery, the surgical floor, telemetry ward, and intensive care unit. Factors determining a patient's disposition include their preoperative health, procedure performed, and postoperative clinical status. The document also discusses common postoperative orders related to tubes, drains, oxygen therapy, and wound care to guide nursing staff.
Postoperative pain is a complex experience involving sensory, emotional, and mental components. Effective pain management is important for patient comfort and recovery. Guidelines for postoperative pain treatment have been developed for specific procedures. Multimodal analgesic regimens targeting multiple pathways are recommended over reliance on opioids alone to prevent tolerance and hyperalgesia. Nonpharmacological complementary therapies can be combined with drug treatments to enhance pain control.
The document discusses the approach to a patient experiencing ongoing bleeding. It outlines the following key steps:
1. First consider the possibility of a technical cause like an unligated vessel and examine for injuries.
2. If no technical cause is found, check the patient's temperature and perform laboratory tests. Hypothermia can cause coagulopathy.
3. Evaluate test results along with the patient's history for clues to underlying causes like platelet dysfunction, coagulation factor deficiencies, or inherited bleeding disorders. Treat the specific condition while continuing evaluation.
A C S0812 Brain Failure And Brain Deathmedbookonline
This document discusses brain failure and brain death. It defines different levels of impaired consciousness from cloudy consciousness to coma. It describes how brain failure results from cardiac arrest and the challenges of restarting the brain after lack of oxygen. It outlines the criteria for diagnosing brain death, including absence of brain stem reflexes and apnea testing. It also discusses the evolution of determining death as technology has allowed life support to prolong vital signs indefinitely.
This document summarizes key points about surgical treatment of early rectal cancer and care of elderly surgical patients. It discusses that radical resection for early rectal cancer achieves excellent local control but has risks, while local excision may be preferable but has a higher local recurrence rate. Adjuvant therapy after local excision may help address this. It also notes that the elderly population is growing and physiologic changes with aging, like cardiac function decline, must be considered in surgical planning and risk assessment for elderly patients. Functional status is more important than age alone.
This document provides information on parotidectomy surgery and the Fundamentals of Laparoscopic Surgery (FLS) program.
It describes the technique for parotidectomy surgery, including identifying and dissecting around the facial nerve. It notes that most parotid tumors are benign and complications are usually temporary facial nerve paralysis.
It then discusses the development of the FLS program to standardize laparoscopic surgery training. The program includes cognitive training and manual skills assessment. Many residency programs and hospitals now require surgeons to complete the FLS. A large grant will help make the program more accessible to residency programs.
This document summarizes an article about volunteer surgeons providing care to wounded soldiers in Iraq and Afghanistan. It discusses the senior visiting surgeon program established by the American College of Surgeons that allows surgeons to volunteer their time. The volunteer rotation described involved caring for patients at Landstuhl Regional Medical Center in Germany as part of the complex medical evacuation process bringing wounded soldiers from war zones to the United States for further treatment and recovery.
1. The document discusses various sources of data for benchmarking surgical outcomes, including public reporting programs, public use administrative databases, and clinical registries. It notes limitations of using administrative data including problems with accuracy, completeness, and clinical precision of coding.
2. Clinical registries like the National Surgical Quality Improvement Program (NSQIP) and the Society of Thoracic Surgeons database are described as better sources of benchmarking data as they provide risk-adjusted outcomes while protecting individual hospital and surgeon confidentiality.
3. Limitations of all surgical benchmarking sources include small sample sizes, lack of generalizability between databases, and lack of external auditing to ensure accuracy and completeness of submitted data.
This document discusses organ procurement from cadaveric donors. It describes the coordination between donor and recipient activities, including matching organs to recipients based on factors like blood type, medical urgency, and waiting time. The evaluation of donor organs is outlined for different organs. Careful donor management aims to optimize organs while respecting donor dignity.
Hand-assisted laparoscopic surgery (HALS) is a hybrid technique that provides many of the advantages of traditional open surgery and laparoscopic colectomy. HALS employs a special access device that allows the surgeon to place a hand in the abdomen to assist with retraction, dissection, and visualization while maintaining pneumoperitoneum and laparoscopic instrumentation through trocars. Studies have shown HALS results in shorter operative times and lower conversion rates to open surgery compared to traditional laparoscopic colectomy while preserving similar short-term clinical outcomes. HALS may help expand the use of minimally invasive approaches for complex colectomies by providing an easier transition from open surgery than traditional laparoscopic techniques.
The document summarizes the evolution of trauma surgery training and practice in the United States. It discusses how trauma surgery originated in large city hospitals but has since expanded to regional trauma centers. It also notes changes in surgical training away from generalist models towards increased specialization. Trauma surgery is increasingly encompassing broader emergency general surgery duties due to workforce shortages, while training programs emphasize specialized rather than broad skills.