Aki cases-and-messages-2-nov-2017
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This document discusses several cases of acute kidney injury (AKI) in patients with various underlying conditions and risk factors. It explores potential causes of AKI like hepatorenal syndrome (HRS) in a patient with liver cirrhosis, intra-abdominal hypertension-associated acute kidney injury (IAH-ACS), drug-induced AKI from medications like vancomycin, proton pump inhibitors (PPIs), and renin-angiotensin system (RAS) inhibitors. It also addresses atypical presentations of AKI and the optimal renal replacement therapy (RRT) approach.
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Background: The Oxford Classification of IgAN was developed in 2009. Subsequent validation studies found that M and E lesions were less predictive of ESRD. Varying reproducibility and lack of sufficient clinical relevance have since then resulted in several larger studies like the VALIGA study which addressed some of the shortcomings of the Oxford Classification. We had previously reported on a 30 year follow up study of 102 patients with IgA nephritis (IgAN) to validate the Oxford Classification and we showed that E and S lesions of the Oxford MEST were predictive of patients likely to develop renal failure during the initial 5 years of the disease whereas M and T scores were predictive of late renal failure as shown in our 30 years follow up of these patients. In this follow up study we explore how we could expand the relevant histological features of the MEST score as well as include some clinical indices to make the Oxford Classification more relevant clinically.
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Previous studies often regards elevation of serum lactate dehydrogenase (LDH) level as an auxiliary
diagnosis marker when judging myocardial diseases.
Methods: We analyzed the serum LDH levels in newly confirmed KD patients, compared with
febrile non-KD patients and healthy donors as controls. Then a subtype of LDH protein (LDHA) were
over-expressed and purified for antigenicity analysis of potential anti-LDHA autoantibodies in IgA, IgM
and IgG isotype by homemade ELISA, respectively.
Results: An obvious elevation serum levels of LDH was found in 5/27 KD patients (19%, p<0.05) /><0.001). None of IgA or IgM isotype of anti-LDHA antibodies
were detected in all cases, and only low titer IgG antibodies were detected in KD patients (7%) and
febrile non-KD patients (11%).
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Aloe vera ( Ghrit-Kumari)
The Aloe vera plant has been known and used for centuries for its, beauty health, medicinal, skin care and other various properties. It has a vast traditional role in the indigenous system of medicine like Ayurveda, Siddha, Unani and homeopathy. Aloe barbadensis miller is the botanical name of Aloe vera. Aloe vera, commonly known as Barbados, considered as a magical plant. The arborescent, perennial, xerophytic, succulent plant mainly grows in subtropical areas. Aloe vera is considered to be a storehouse of phytochemicals. The plant leaves contain lots of chemical constituents such as anthraquinones, carbohydrates, vitamins, steroids, mineral, other inorganic and organics substances. Bioactive compounds from Aloe vera are very effective in various treatments, such as burns, allergic reactions, rheumatoid arthritis, rheumatic fever, acid indigestion, ulcers, skin diseases, diabetes, dysentery, diarrhoea, piles and inflammatory conditions of the digestive system and other internal organs, including the stomach, small intestine, liver, kidney, and pancreas. The active ingredients from Aloe vera have been shown to have analgesic, anti-inflammatory, antioxidant and anticancer agent. The plant also contains a lot of enzymes that regulate different types of reaction in our body. The cosmetics value of the plant is high from other plants.
Aki updated
Acute renal failure (ARF) is a common and serious problem in clinical medicine. It is characterized by an abrupt reduction (usually within a 48-h period) in kidney function.
This results in an accumulation of nitrogenous waste products and other toxins. Many patients become oliguric (low urine output) with subsequent salt and water retention. In
patients with pre-existing renal impairment, a rapid decline
in renal function is termed ‘acute on chronic renal failure’.
The nomenclature of ARF is evolving and the term acute
kidney injury (AKI) is being increasingly used in clinical
practice.
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This review article discusses microvascular and macrovascular disease in systemic hypertension. It summarizes that:
1) Cardiac imaging plays a crucial role in risk stratifying hypertensive patients and identifying management strategies by properly diagnosing microvascular and coronary artery disease.
2) The nitric oxide synthase (eNOS) G298 gene allele may be a marker for microvascular angina in hypertensive patients, as studies have found it to be more prevalent in hypertensive patients with chest pain and reversible myocardial defects but normal coronary arteries.
3) Both structural changes like capillary rarefaction and functional changes like endothelial dysfunction can cause microvascular dysfunction and angina in hypertensive individuals in the absence ofNeurological Manifestation of Anti Phospholipid Syndrome
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Chronic heart disease and Anaemia. Heart failure is a very common disease, with severe morbidity and mortality, and is a frequent reason of hospitalization.
Anemia and a concurrent renal impairment are two major risk factors contributing to the severity of the outcome.
Heme iron is absorbed through a separate pathway and does not have to be discontinued when intravenous treatment is started. This can allow for longer intervals between resource-heavy, inconvenient and painful injections. Oxidative stress is also avoided.
Heme iron does not need to be discontinued during injection or EPO therapy like non-heme oral iron.
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This document summarizes guidelines from 5 medical societies regarding intensive hemodialysis. The guidelines agree that increasing hemodialysis time or frequency should be considered for patients with large weight gains, high ultrafiltration rates, poorly controlled blood pressure, difficulty achieving dry weight, or poor metabolic control. Specifically, the guidelines recommend intensive hemodialysis for patients with refractory fluid overload, uncontrolled hypertension, hyperphosphataemia, cardiovascular disease, hemodynamic instability, or impaired phosphate control. The conclusion states that physician judgment combined with clinical guidelines should guide decisions about intensive hemodialysis for patients.lactate-dehydrogenase-is-involved-in-but-not-the-target-antigen-in-children-w...
lactate-dehydrogenase-is-involved-in-but-not-the-target-antigen-in-children-w...Peertechz Publications
Background: Kawasaki disease (KD) is an acute vasculitis often complicating coronary arterial
lesions, and gradually becomes the leading cause of acquired heart disease instead of rheumatism.
Previous studies often regards elevation of serum lactate dehydrogenase (LDH) level as an auxiliary
diagnosis marker when judging myocardial diseases.
Methods: We analyzed the serum LDH levels in newly confirmed KD patients, compared with
febrile non-KD patients and healthy donors as controls. Then a subtype of LDH protein (LDHA) were
over-expressed and purified for antigenicity analysis of potential anti-LDHA autoantibodies in IgA, IgM
and IgG isotype by homemade ELISA, respectively.
Results: An obvious elevation serum levels of LDH was found in 5/27 KD patients (19%, p<0.05) /><0.001). None of IgA or IgM isotype of anti-LDHA antibodies
were detected in all cases, and only low titer IgG antibodies were detected in KD patients (7%) and
febrile non-KD patients (11%).
Conclusions: Our results demonstrated the LDH was associated but not the main autoimmune
target in children with KD.When to Initiate RRT in Patients with AKI - Does Timing Matter?
Acute kidney injury is a serious illness which occurs commonly in the renal units and also in the ICU setting. It is an independent risk factor of increased mortality and morbidity, particularly when RRT is needed. The wide variation in utilization of RRT contributes to a lack of consensus among clinicians regarding the parameters which should guide the decision to initiate RRT.
Advancing Dialysis - Intensive Hemodialysis
Five medical societies from North America, Europe, and Asia have released clinical practice guidelines since 2006 that largely agree intensive hemodialysis should be considered for patients with:
- Large weight gains between treatments
- High rates of fluid removal during treatments
- Poorly controlled blood pressure
- Difficulty achieving their dry weight
- Poor control of minerals like phosphorus or potassium
The guidelines indicate intensive hemodialysis may help patients with these issues by providing more frequent or longer hemodialysis sessions. Physician judgment is also important when determining if intensive hemodialysis is appropriate for a given patient.
Anticoagulant Use and Risk of Ischemic Stroke and Bleeding in Patients With S...
This study examined the risks of ischemic stroke and bleeding in 2,304 patients over 65 years old who were hospitalized with secondary atrial fibrillation (AF) associated with acute coronary syndrome (ACS), acute pulmonary disease, or sepsis. The patients had high risk scores for stroke and bleeding. While most patients received anticoagulants, the study found anticoagulant use did not lower ischemic stroke risk overall and increased bleeding risk in those with pulmonary disease. Thus, the benefits of anticoagulation for secondary AF linked to ACS, pulmonary disease, or sepsis remain unclear.
papers
This document appears to be a curriculum vitae or resume for Stephen G. Nuara listing publications, presentations, and abstracts related to research with rodent and primate models. It includes over 15 publications, many involving studies on the effects of transient middle cerebral artery occlusion in rats. It also lists over 15 invited presentations given by Nuara on topics like working with non-human primates, the common marmoset, and advanced non-human primate methodology. Abstracts involved are related to the effects of left versus right middle cerebral artery occlusion on immune responses in rats.
A cardiac MRI study
This document summarizes a study examining the relationship between electrocardiographic Q waves and evidence of myocardial infarction detected by cardiac magnetic resonance imaging in patients with type 2 diabetes. The study followed 36 patients with diabetes and no history of coronary heart disease over 5 years, recording annual electrocardiograms. Some patients developed new Q waves that often resolved within 2 years. Cardiac MRI detected prior myocardial infarction in only 3 patients, and these findings did not correlate with Q wave patterns on electrocardiograms. The results suggest Q waves may be unreliable indicators of silent myocardial infarction in patients with type 2 diabetes.
When to Initiate RRT in Patients with AKI - Does Timing Matter?
Acute kidney injury is a serious illness which occurs commonly in the renal units and also in the ICU setting. It is an independent risk factor of increased mortality and morbidity, particularly when RRT is needed. The wide variation in utilization of RRT contributes to a lack of consensus among clinicians regarding the parameters which should guide the decision to initiate RRT. This problem is confounded by a paucity of high quality evidence in the current literature. This review examines the role of usual biochemical parameters as well as conventional clinical indications for commencing RRT. It also discusses the potential role of biomarkers as predictors for the need of RRT in AKI. Initiating dialysis in AKI should be based on dynamic clinical criteria and not only on specific biochemical values.
When to initiate RRT in patients with AKI - Does timing matter?
When to initiate RRT in patients with AKI remains an area of debate due to lack of consensus on the optimal timing. The document reviews evidence on using various biochemical parameters and clinical indicators to guide RRT initiation. Studies have shown conflicting results for triggers like serum creatinine, urea, and oliguria. Earlier initiation of RRT may improve outcomes by preventing fluid overload, though high-quality randomized trials are still needed to definitively establish best practices. The cause of AKI and individual patient factors are also important considerations in determining optimal timing.
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When to Initiate RRT in Patients with AKI - Does Timing Matter?
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Anticoagulant Use and Risk of Ischemic Stroke and Bleeding in Patients With S...
When to Initiate RRT in Patients with AKI - Does Timing Matter?
When to Initiate RRT in Patients with AKI - Does Timing Matter?
When to initiate RRT in patients with AKI - Does timing matter?
When to initiate RRT in patients with AKI - Does timing matter?
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Aloe vera ( Ghrit-Kumari)
The Aloe vera plant has been known and used for centuries for its, beauty health, medicinal, skin care and other various properties. It has a vast traditional role in the indigenous system of medicine like Ayurveda, Siddha, Unani and homeopathy. Aloe barbadensis miller is the botanical name of Aloe vera. Aloe vera, commonly known as Barbados, considered as a magical plant. The arborescent, perennial, xerophytic, succulent plant mainly grows in subtropical areas. Aloe vera is considered to be a storehouse of phytochemicals. The plant leaves contain lots of chemical constituents such as anthraquinones, carbohydrates, vitamins, steroids, mineral, other inorganic and organics substances. Bioactive compounds from Aloe vera are very effective in various treatments, such as burns, allergic reactions, rheumatoid arthritis, rheumatic fever, acid indigestion, ulcers, skin diseases, diabetes, dysentery, diarrhoea, piles and inflammatory conditions of the digestive system and other internal organs, including the stomach, small intestine, liver, kidney, and pancreas. The active ingredients from Aloe vera have been shown to have analgesic, anti-inflammatory, antioxidant and anticancer agent. The plant also contains a lot of enzymes that regulate different types of reaction in our body. The cosmetics value of the plant is high from other plants.
Aki updated
Acute renal failure (ARF) is a common and serious problem in clinical medicine. It is characterized by an abrupt reduction (usually within a 48-h period) in kidney function.
This results in an accumulation of nitrogenous waste products and other toxins. Many patients become oliguric (low urine output) with subsequent salt and water retention. In
patients with pre-existing renal impairment, a rapid decline
in renal function is termed ‘acute on chronic renal failure’.
The nomenclature of ARF is evolving and the term acute
kidney injury (AKI) is being increasingly used in clinical
practice.
Aki dr osama el shahat 2017
This document discusses acute kidney injury (AKI), including its definition, classification systems, causes, biomarkers, treatment, and management. It provides a brief history of terms used to describe AKI and summarizes current classification systems. It also outlines causes of AKI, the advantages of various biomarkers for early detection, and general principles and indications for renal replacement therapy (RRT). Modalities of RRT including peritoneal dialysis, intermittent hemodialysis, slow low-efficiency dialysis, and continuous renal replacement therapy are compared.
Acute kidney injury (aki)
The document discusses acute kidney injury (AKI). It defines AKI and outlines its causes including pre-renal, intrinsic renal, and post-renal etiologies. Diagnosis involves evaluating history, examination for volume status, and investigations such as blood tests, urinalysis, and imaging. Urinalysis can provide clues to the etiology such as presence of red blood cells or casts. Ultrasound is useful for assessing kidney size and detecting obstruction. Managing the underlying cause and treating complications are important in AKI.
Abcde, bls, als
This document provides information on assessing and managing critically ill patients using the ABCDE approach. It discusses:
- Common early signs of critical illness including hypoxia and hypotension.
- The ABCDE approach which prioritizes establishing a patient's airway, breathing, circulation, disability level and exposure for examination.
- Techniques for assessing and intervening on airway, breathing and circulation issues including providing oxygen, treating underlying causes, and starting IV fluids.
- The importance of continuous reassessment, calling for help early, and following basic life support protocols when indicated to stabilize critically ill patients.
Acute kidney injury in children
This document provides an overview of acute kidney injury (AKI) including renal anatomy and physiology, epidemiology, definitions, diagnosis, biomarkers, and treatment. It discusses the kidney's role in fluid, electrolyte and waste regulation. AKI is common, affecting 5-30% of hospitalized or ICU patients. New definitions classify AKI severity into Risk, Injury and Failure stages based on creatinine and urine output. Causes include pre-renal, intrinsic renal and post-renal factors. Treatment focuses on fluid management, electrolyte control, nutrition and preventing complications through dialysis if needed. Biomarkers show promise in early AKI detection but management primarily relies on supportive care as no targeted therapies exist
Acute Kidney Injury
the presentation highlights on the approach of a patient with AKI: i.e History, physical findings, investigations
Acute and Chronic Renal Failure. Easy Slides.
The document provides information on acute and chronic renal failure. It discusses the etiology, pathophysiology, symptoms, diagnostic tests, and management of acute renal failure. It also covers the introduction, etiology, symptoms, stages, treatment, and prevention of chronic renal failure. The key differences between non-dialysis dependent chronic kidney disease and end-stage renal disease are also outlined.
Acute renal failure
Acute renal failure is a sudden reduction in kidney function that results in waste accumulating in the blood. It can be caused by problems affecting blood flow to the kidneys like dehydration, blood loss from major surgery or burns, or kidney problems preventing proper filtration. Symptoms include reduced urination, swelling, fatigue, and shortness of breath. Treatment focuses on fluid balance, electrolytes, nutrition, and preventing complications like infection that can further stress the kidneys.
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How to retard ckd progression 7 dec 2018
This document discusses chronic kidney disease (CKD) and strategies to retard its progression. It covers CKD epidemiology and risk factors like hypertension, diabetes, metabolic acidosis, sleep quality, uric acid levels, antibiotic use, gut microbiome, herbal remedies, nutrition, exercise, and weight management. Later sections discuss roles of primary care providers, predicting disease course, and virtual learning through the ESNT Virtual Academy. The overall goal is to review current knowledge on modifiable factors that impact CKD progression and identify opportunities for improved prevention and management of kidney disease.
Evolution of interventional nephrology. prof. hussein sheashaa (1)
This document discusses the evolution of interventional nephrology over time. It summarizes key developments including the first use of hemodialysis shunts and percutaneous catheters in the 1960s, the growing role of nephrologists in vascular access procedures and peritoneal dialysis catheter placement in the 1990s-2000s, and the establishment of dedicated dialysis access centers in the 2010s to improve vascular access outcomes. It also outlines the expanding scope of interventional nephrology training programs to include procedures like biopsy, angioplasty, and fistula maturation.
Ekg
This study assessed the relationship between electrocardiographic (ECG) left ventricular hypertrophy (LVH) and blood pressure (BP) control in 17,312 hypertensive patients from China. 1) 8.1% of patients had ECG-LVH, which was more prevalent in males. 2) Patients with ECG-LVH had a significantly higher rate of unsatisfactory BP control, with an odds ratio of 1.42, compared to those without ECG-LVH. 3) Notable differences in BP control were also seen between males and females and in patients with diabetes, with ECG-LVH patients having poorer control.
23
This study analyzed angiographic data from 3,428 patients who underwent percutaneous coronary intervention (PCI) for non-ST-segment elevation acute coronary syndrome in the ACUITY trial to determine the incidence and impact of intraprocedural thrombotic events (IPTE). IPTE occurred in 121 patients (3.5%) and was associated with significantly higher rates of major adverse cardiac events, including death, myocardial infarction, and stent thrombosis at in-hospital, 30-day, and 1-year follow-up compared to patients without IPTE. IPTE was an independent predictor of adverse outcomes at 30 days and 1 year after adjusting for other factors. The results suggest that although infrequent, IPTE during PCI for acute
Clinical Predictors of the Evolving Ischemic Stroke according to the Tree-St...
Clinical Predictors of the Evolving Ischemic Stroke according to the Tree-St...EVANS Community Adult School, Los Angeles, USA
Techniques in Neurosurgery & Neurology
Authors:
Irina Gontschar1 and Igor Prudyvus2
1Student, Health Information Management and Insurance Billing Program by the EVANS Community Adult School, Los Angeles, USA
2Chief Application Support Analysts, EPAM Systems, Minsk, Belarus
Abstract
Introduction: The purpose of the study is to identify the independent clinical predictors of the evolving ischemic stroke (EIS) according to the tree-structured model.
Methods and Materials: The objects of the study were 1421 patients with ischemic stroke (IS), hospitalized within 48 hours from the development of the initial symptoms. Patients with IS were admitted to the 5th Minsk City Clinical Hospital and the Minsk Emergency Hospital (Belarus) in 2002-2014 years. Evolving clinical course of the stroke is defined as an increase in the severity of neurological deficit by 2 or more points on the NIHSS scale or the death of the patient during the first seven days of hospitalization. The research is characterized due to the prospective-data-collection, and the retrospective evaluation design. The statistical method of decision trees and an algorithm of the conditional inference trees were used to create the prognostic model of EIS. Statistical data analysis was carried out applying the software packages of R V.3.2.5 and IBM SPSS Statistics 26.0.
Results: The rate of EIS reached 30%. The patients with EIS were 72.6±10.2 years old, patients without EIS - 68.1±11.3 years; p = 0.005. Previously, 22 clinical, demographic, laboratory variables accommodated in the computer database were included in the conditional inference trees statistical algorithm. The prognostic statistical model of EIS has been constructed. The following independent predictors of evolving IS were identified: the stroke subtype according to the Oxford Community Stroke Project classification, the serum urea level, and red blood cell number in the total blood count. The accuracy of the statistical model reaches 0.77 (95% CI: 0.75; 0.80), the sensitivity is 0.52, the specificity - 0.88, PPV - 0.66, and NPV - 0.81; p < 0.001.
Conclusion: The tree-structural model allowed us to identify the independent clinical predictors of EIS.
Keywords: Cerebral infarction, Clinical characteristics, Clinical course, Conditional inference trees algorithm, Decision tree, Evolving ischemic stroke, Model, Predictor, Prognosis, Stroke deterioration
1110414-降低糖尿病患者罹患心腎疾病的風險跟血糖達標一樣重要.pdf
This document summarizes key information about chronic kidney disease (CKD) and cardiovascular disease (CVD). It notes that patients with CKD should be considered at the highest risk for CVD. Lower estimated glomerular filtration rate (eGFR) is associated with higher risks of coronary disease and CVD mortality. The risks of all-cause mortality are significantly higher across all levels of eGFR and proteinuria for patients with early diabetic kidney disease compared to those without. Heart failure hospitalization risk increases as kidney function declines. The development of macroalbuminuria in diabetes patients heralds a rapid decline in glomerular filtration rate. Timely protection and maintenance of kidney function can reduce CVD risks.
Аллопуринол и прогрессирование ХБП и кардиоваскулярные события. РКИ / Allopur...
Allopurinol and Progression of CKD and Cardiovascular Events- Long-term Follow-up of a Randomized Clinical Trial.Am J Kidney Dis. 2015 Apr
Background:Asymptomatic hyperuricemia increases renal and cardiovascular (CV) risk. We previously
conducted a 2-year, single-blind, randomized, controlled trial of allopurinol treatment that showed improved
estimated glomerular filtration rate and reduced CV risk.
Study Design:Post hoc analysis of a long-term follow-up after completion of the 2-year trial.
Setting & Participants:113 participants (57 in the allopurinol group and 56 in the control group) initially
followed up for 2 years and 107 participants followed up to 5 additional years.
Intervention: Continuation of allopurinol treatment, 100 mg/d, or standard treatment.
Outcome:Renal event (defined as starting dialysis therapy and/or doubling serum creatinine and/or$50%
decrease in estimated estimated glomerular filtration rate) and CV events (defined as myocardial infarction,
coronary revascularization or angina pectoris, congestive heart failure, cerebrovascular disease, and peripheral vascular disease).
Results:During initial follow-up, there were 2 renal and 7 CV events in the allopurinol group compared with
6 renal and 15 CV events in the control group. In the long-term follow-up period, 12 of 56 participants taking
allopurinol stopped treatment and 10 of 51 control participants received allopurinol. During long-term follow-up,
an additional 7 and 9 participants in the allopurinol group experienced a renal or CV event, respectively, and an
additional 18 and 8 participants in the control group experienced a renal or CV event, respectively. Thus,
during the initial and long-term follow-up (median, 84 months), 9 patients in the allopurinol group had a
renal event compared with 24 patients in the control group (HR, 0.32; 95% CI, 0.15-0.69; P50.004;
adjusted for age, sex, baseline kidney function, uric acid level, and renin-angiotensin-aldosterone system
blockers). Overall, 16 patients treated with allopurinol experienced CV events compared with 23 in the
control group (HR, 0.43; 95% CI, 0.21-0.88;P50.02; adjusted for age, sex, and baseline kidney function).
Limitations:Small sample size, single center, not double blind, post hoc follow-up and analysis.
Conclusions: Long-term treatment with allopurinol may slow the rate of progression of kidney disease and
reduce CV risk.
International Journal of Clinical Endocrinology
Aim: To study the value of BNP as a screening tool to identify silent ischemia and diastolic dysfunction in asymptomatic type II
diabetic patients.
Objectives: The objective of the study is how far BNP value will be useful in early detection of LV dysfunction and ischemia without subjecting the patient to treadmill test and ECHO, as both are even though specific but not sensitive. Our effort is to identify a simple blood test which is highly sensitive in identifying them.
clopidogril and ACS
- Polyvascular disease, where a patient has atherosclerosis in more than one vascular bed (e.g. coronary, carotid, and peripheral arteries) is common, with around 25-60% of patients with disease in one bed also having it in others.
- Patients with polyvascular disease have higher rates of cardiovascular events than those with single-bed disease.
- Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor such as clopidogrel or ticagrelor is frequently used long-term or lifelong in patients with polyvascular disease to reduce the risk of future cardiovascular events.
Lushchyk et al. the epma journal
The document discusses strategies for improving cardiovascular disease diagnosis and treatment in Ukraine. It argues that current approaches are insufficient as they focus on static examination of individual vascular segments rather than a dynamic, integrated analysis of the entire cardiovascular system. The article recommends predictive, preventive, and personalized medicine approaches using new technologies developed in Ukraine, such as ultrasound dopplerography, that allow comprehensive examination of vascular function and blood flow dynamics. Clinical trials of these innovative strategies showed improved treatment outcomes compared to conventional methods.
Nej moa1105594
This study investigated the risks of stroke, bleeding, and thromboembolism in patients with atrial fibrillation and chronic kidney disease. The study used Danish national registries to identify over 132,000 patients hospitalized for atrial fibrillation between 1997-2008. Patients with non-end stage chronic kidney disease had a 49% higher risk of stroke or thromboembolism compared to those without renal disease. Patients requiring dialysis had an 83% higher risk. Warfarin reduced these risks for both groups of patients with chronic kidney disease but increased bleeding risk. Thus, chronic kidney disease increases the risks of stroke and bleeding in atrial fibrillation patients, and warfarin decreases stroke risk but increases
Anemia pres 20 feb 2017
This document summarizes key aspects of anemia management in chronic kidney disease (CKD). It discusses definitions of anemia and its impacts. It reviews treatment strategies including iron supplementation, erythropoiesis-stimulating agents (ESAs), adjuvants, and hypoxia-inducible factor stabilizers. It addresses issues like ESA resistance and hypo-responsiveness, and special topics such as the risks of ESAs and hemoglobin targets. The overall document provides a comprehensive overview of evaluating and managing anemia in CKD.
Anemia pres 20 feb 2017
This document summarizes key aspects of anemia management in chronic kidney disease (CKD). It discusses definitions of anemia and its impacts. It reviews treatment strategies including iron supplementation, erythropoiesis-stimulating agents (ESAs), adjuvants, and hypoxia-inducible factor stabilizers. It addresses issues like ESA resistance, hyporesponsiveness, and special patient populations. The goal is to provide clinicians an overview of evaluating and managing anemia in CKD to maximize benefits and minimize risks.
Nephroradiology pres-course-13-april-2017 (1)
This document discusses what information nephrologists need from radiologists. It covers various imaging modalities like ultrasound, CT, MRI, and biopsy. It provides details on assessing kidney function using CT, measuring kidney volumes, evaluating complications like calciphylaxis. It also discusses contrast-induced acute kidney injury and the precautions needed for renal biopsy.
Jonathan G Stine, Puja M Shah, Scott L Cornella, Sean R Rudnic.docx
Jonathan G Stine, Puja M Shah, Scott L Cornella, Sean R Rudnick, Marwan S Ghabril, George J Stukenborg,
Patrick G Northup
Jonathan G Stine, Sean R Rudnick, Patrick G Northup,
Division of Gastroenterology and Hepatology, University of
Virginia, Charlottesville, VA 22908, United States
Puja M Shah, Department of Surgery, University of Virginia,
Charlottesville, VA 22908, United States
Scott L Cornella, Department of Medicine, University of
Virginia, Charlottesville, VA 22908, United States
Marwan S Ghabril, Division of Gastroenterology and Hepatology,
Indiana University, Indianapolis, IN 46202, United States
George J Stukenborg, Department of Public Health Science,
University of Virginia, Charlottesville, VA 22908, United States
Author contributions: Stine JG and Shah PM contributed equally
to this work; Stine JG, Shah PM, Ghabril MS, Stukenborg GJ
and Northup PG designed research; Stine JG, Shah PM, Cornella
SL and Rudnick SR performed research; Stine JG and Shah PM
analyzed data; Stine JG, Shah PM, Cornella SL, Rudnick SR,
Ghabril MS, Stukenborg GJ and Northup PG wrote the paper.
Supported by (In part) grant funding from the National
Institutes of Health (Grant 5T32DK007769-15); and NIH-
Surgical Oncology grant (T32 CA163177).
Conflict-of-interest statement: We have no conflicts of interest
to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was
selected by an in-house editor and fully peer-reviewed by external
reviewers. It is distributed in accordance with the Creative
Commons Attribution Non Commercial (CC BY-NC 4.0) license,
which permits others to distribute, remix, adapt, build upon this
work non-commercially, and license their derivative works on
different terms, provided the original work is properly cited and
the use is non-commercial. See: http://creativecommons.org/
licenses/by-nc/4.0/
Correspondence to: Jonathan G Stine, MD, MSc, Division
of Gastroenterology and Hepatology, University of Virginia, JPA
and Lee Street, MSB 2145, PO Box 800708, Charlottesville, VA
22908, United States. [email protected]
Telephone: +1-434-9242959
Fax: +1-434-2447529
Received: September 18, 2015
Peer-review started: September 19, 2015
First decision: October 21, 2015
Revised: November 2, 2015
Accepted: November 10, 2015
Article in press: November 11, 2015
Published online: November 28, 2015
Abstract
AIM: To determine the clinical impact of portal vein
thrombosis in terms of both mortality and hepatic
decompensations (variceal hemorrhage, ascites, por-
tosystemic encephalopathy) in adult patients with
cirrhosis.
METHODS: We identified original articles reported
through February 2015 in MEDLINE, Scopus, Science
Citation Index, AMED, the Cochrane Library, and
relevant examples available in the grey literature. Two
independent reviewers screened all citations for inclu-
sion criteria and extracted summary data. Random
effects odds rati ...
International Journal of Nephrology & Therapeutics
Introduction: Chronic Kidney Disease (CKD) is a worldwide public health problem and it is increasing over time. Cardiovascular disease is a major concern for patients with end stage renal disease, especially those on hemodialysis. It is the leading cause of death among patients with chronic kidney
disease, particularly in dialysis population.
Sepsis modern day killer
This document discusses sepsis and its treatment options. It begins by stating that sepsis is a modern day killer and discusses the best treatment options as presented by Dr. Prashant Nasa. It then provides statistics on the rising incidence of sepsis in the United States if projected trends continue. It compares the incidence of sepsis to other major diseases. The document discusses various sepsis treatment guidelines and definitions including the Surviving Sepsis Campaign and Sepsis-3. It reviews fluid resuscitation and vasopressor options for sepsis, including debates around various fluids, vasopressors, and resuscitation protocols. It emphasizes the importance of fluid stewardship in sepsis treatment.
Impact_of_amount_of_fluid_for_circulatory_resuscit.pdf
This study aims to establish new parameters to guide fluid resuscitation in shock therapy and reduce the risk of acute kidney injury (AKI). The study will measure intra-abdominal pressure, renal resistive index, sublingual microcirculation, and total body water in patients with shock and correlate these values with the occurrence of AKI and need for renal replacement therapy. The study is an observational clinical trial that has recruited 33 patients so far and expects final results in late 2018. It hypothesizes that integrating new regional measurements into fluid resuscitation guidance can lower AKI rates and renal replacement therapy needs compared to using only standard hemodynamic parameters.
HNDM proceedings of November 2016,Singapore
The document describes a conference on biotechnology, bioinformatics, biomedical sciences and stem cell applications taking place from November 11-12, 2016 in Singapore. It provides the conference schedule, list of speakers, and abstracts of papers being presented on topics related to diabetes, hypertension, cardiovascular disease, cognitive functions and thrombogenesis. The conference will bring together researchers from various universities and institutions in Asia to present and discuss their work in healthcare, life sciences and stem cell applications.
A Study On Clinical Profile Of Sepsis Patients In Intensive Care Unit Of A Te...
Background : Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection which is one of the most important cause of mortality & morbidity in critically ill patients. In this study clinical profiles of the sepsis patients admitted in ICU in this part of India have been evaluated. Methods & Materials: This prospective hospital based observational study was undertaken in the department of Emergency Medicine ICU of Gauhati Medical College & Hospital, over a period of one year from August 2014 to July 2015 after obtaining institutional ethical committee clearance.
RESULTS: Clinical profiles of 50sepsis patients, with male preponderance (56%) & mortality rate 36% were studied. Mean age was 48.36 years (SD ±17.16). fever & tachycardia were present in all patients. 30 patients (60%) required ventilatory support, 28 patients (56%) required inotropic support, 10 patients (20%) required dialysis. Gram negative bacteria were found to be the predominant pathogens associated with sepsis(73.4%) where most common organism responsible was Klebsiella (36.8%). Conclusion : assessment of clinical signs & initial serological & radiological investigations are of utmost importance to detect more critically ill patients as early as possible to intervene earlier for saving the life of the sepsis patients.
Similar to Aki cases-and-messages-2-nov-2017 (20)
Evolution of interventional nephrology. prof. hussein sheashaa (1)
Evolution of interventional nephrology. prof. hussein sheashaa (1)
Clinical Predictors of the Evolving Ischemic Stroke according to the Tree-St...
Clinical Predictors of the Evolving Ischemic Stroke according to the Tree-St...
Аллопуринол и прогрессирование ХБП и кардиоваскулярные события. РКИ / Allopur...
Аллопуринол и прогрессирование ХБП и кардиоваскулярные события. РКИ / Allopur...
Jonathan G Stine, Puja M Shah, Scott L Cornella, Sean R Rudnic.docx
Jonathan G Stine, Puja M Shah, Scott L Cornella, Sean R Rudnic.docx
International Journal of Nephrology & Therapeutics
International Journal of Nephrology & Therapeutics
Impact_of_amount_of_fluid_for_circulatory_resuscit.pdf
Impact_of_amount_of_fluid_for_circulatory_resuscit.pdf
A Study On Clinical Profile Of Sepsis Patients In Intensive Care Unit Of A Te...
A Study On Clinical Profile Of Sepsis Patients In Intensive Care Unit Of A Te...
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The document provides historical background on the development of peritoneal dialysis (PD) and outlines its use in acute kidney injury (AKI). It discusses:
1. The first experiments using the peritoneal cavity for uremia removal in the 1920s.
2. The development of intermittent PD in the 1960s and continuous ambulatory PD in the 1970s.
3. Evidence that high doses of continuous PD can provide appropriate metabolic control in AKI, with survival and renal recovery rates similar to other renal replacement therapies.
4. Indications for acute PD include hemodynamic instability and bleeding risks, while contraindications include recent abdominal surgery and severe peritonitis.
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This document provides an outline and summary of a presentation on diabetic kidney disease (DKD). It discusses:
1. The epidemiology, presentation, and trends of DKD.
2. The pathology and biomarkers of DKD.
3. The management of DKD, including the use of RAAS blockers, anti-hyperglycemic drugs like SGLT2 inhibitors and GLP1 RAs, and renal replacement therapies.
4. It concludes with a discussion of taking a holistic approach to DKD and lessons that can be learned from basic research on autophagy.
Gn master class
The document discusses several cases of glomerular disease:
1) A 27-year-old male with nephrotic syndrome and a kidney biopsy showing IgG and C3 deposits along the glomerular basement membrane consistent with membranous nephropathy.
2) A 78-year-old female admitted with nephrotic syndrome after a history of NSAID use, with a biopsy showing focal segmental glomerulosclerosis.
3) A 26-year-old male with nephrotic syndrome and renal impairment, whose biopsy demonstrated membranoproliferative glomerulonephritis with C3 deposition and subendothelial electron dense deposits. Follow up showed elevated
Ibrahim
A 30-year-old man presented with lower limb swelling, shortness of breath, and decreased urine output for 2 weeks. He had a history of drug abuse including heroin, tramadol, and marijuana. Initial labs showed severe kidney dysfunction with a creatinine of 7.5 mg/dl. A renal biopsy was performed which showed acute tubular injury, focal interstitial nephritis with eosinophil infiltrate, and mesangial proliferative glomerulonephritis. He was started on hemodialysis and steroids. After treatment, his kidney function improved and he was discharged with a creatinine of 1.5 mg/dl.
Aya elsaeid 1
A 19-year-old male gym player presented with decreased urine output, fatigue, loss of appetite, joint pain, nausea, and vomiting for one week. Lab results showed impaired renal function. He has a history of artheralgia treated with long-acting penicillin. Investigations showed positive ANA and anti-ds DNA. A renal biopsy was done which revealed lupus nephritis class 4, indicating an active inflammation. The treatment plan includes high dose steroids, immunosuppressants, and supplements.
Interstial nephr mohamed abdallah
This document discusses tubulointerstitial nephritis (TIN), a pattern of renal injury characterized by inflammation and edema of the renal tubules and interstitium. TIN is most commonly caused by drugs (71% of cases) and infections (15% of cases). On biopsy, TIN shows lymphocytic infiltration of the tubules and interstitium with tubular atrophy and normal glomeruli and vessels. Treatment involves withdrawing the offending agent and supportive care. Corticosteroids may aid recovery but their effectiveness is debated. Prognosis depends on factors like duration of the insult and degree of fibrosis - complete recovery is more likely if treatment begins early.
Fasting ramadan nephrology prospective prof. osama el shahate
Dr. Osama El-Shahat is the head of the nephrology department at New Mansoura General Hospital and vice president of the Dakahlia Nephrology Group. The document discusses kidney disease (CKD), transplantation, dialysis, and recommendations. It provides examples of how some animals fast during certain periods by not eating and reducing activity. It also discusses fasting guidelines for patients with illnesses, noting that those with more severe illnesses should generally be exempted from fasting. The document analyzes a study on the effects of Ramadan fasting on renal function in CKD patients and notes that more large studies are needed. It also reviews a case of a hypertensive patient wanting to fast for Ramadan
Ramadan fasting & kidney disease may 2019
Ramadan fasting is a unique metabolic model that consists of alternating periods of fasting and feasting rather than continuous fasting. During the fast, the body breaks down fat stores and releases fatty acids into the bloodstream to be used for energy. This process can help eliminate toxins from the fatty acids. Fasting has also been shown to help reduce inflammation and support the immune system. However, fasting also carries risks and may not be appropriate for certain groups like pregnant women, those with medical conditions, or people on medication. Proper hydration and electrolyte replacement is important when fasting to avoid health issues.
Vascular access 2019
- Short-term catheters should only be used for acute dialysis or limited hospital use. Non-cuffed femoral catheters are only for bed-bound patients.
- Long-term catheters should be used with a plan for permanent access and prefer those capable of high flow rates. Choice depends on local experience and goals.
- Long-term catheters should avoid the same side as a maturing arteriovenous access, if possible.
Parathyroidectomy alshimaa
This document summarizes the medical history and treatment of a 55-year-old male patient with end-stage renal disease on hemodialysis for 17 years and secondary hyperparathyroidism. Medical treatment with cinacalcet and calcitriol was unsuccessful in lowering his high calcium, phosphorus, and PTH levels. Consultations with ENT and cardiology found no issues. The doctor decided that parathyroidectomy was the best option to treat his tertiary hyperparathyroidism that was not responding to medical treatment.
Parathyroidectomy case..abdo-shaban
A 53-year-old male has been undergoing regular hemodialysis for end-stage renal disease (ESRD) for the past 6 years. He has a history of secondary hyperparathyroidism with elevated parathyroid hormone (PTH) levels over 2000. Medical treatment with vitamin D analogs and cinacalcet failed to control his PTH levels. Due to the failure of medical management and severe hyperparathyroidism, the patient is scheduled to undergo parathyroidectomy, which is the recommended treatment in cases of ESRD with tertiary hyperparathyroidism that do not respond to oral medications.
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