Bernstein Mar 11 2009 Anemia Ii
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This document discusses anemia in chronic kidney disease (CKD) and its management. It reviews the pathophysiology of anemia in CKD and guidelines for evaluation. It also discusses the history of US regulatory policies around erythropoiesis-stimulating agent (ESA) use and hemoglobin targets. Several clinical trials found higher hemoglobin levels were associated with worse cardiovascular outcomes without quality of life benefits, suggesting a target range of 11-12 g/dL is appropriate for predialysis CKD patients.
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This document discusses anemia of chronic kidney disease (CKD), including its causes, prevalence, benefits of treatment, evaluation, and treatment with iron and erythropoietic stimulating agents (ESAs). It notes that anemia is common in CKD due to reduced kidney function and erythropoietin production. While untreated anemia can cause many symptoms, managing it with iron and ESAs can improve quality of life and reduce risks. The document provides guidelines on testing, supplementing iron, dosing ESAs, monitoring treatment response, and managing side effects in patients with CKD.
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2. Later generation ESAs like darbepoetin alfa have a longer half-life, allowing less frequent dosing. PEGylated ESAs like CERA have an even longer half-life of 130 hours, permitting monthly dosing.
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2. Later generation ESAs like darbepoetin alfa have a longer half-life, allowing less frequent dosing. PEGylated ESAs like CERA have an even longer half-life of 130 hours, permitting monthly dosing.
3. Other experimental ESAs include those with fused
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Chronic thromboembolic pulmonary hypertension
1) Chronic thromboembolic pulmonary hypertension (CTEPH) is a form of pulmonary hypertension that results from chronic obstruction of the pulmonary arteries by thromboembolic material.
2) CTEPH can be treated through pulmonary endarterectomy (PEA) surgery to remove the obstructive material, which provides long-term benefits. For inoperable cases or persistent PH after PEA, medical therapies targeting the prostacyclin, endothelin, and nitric oxide pathways may provide clinical improvements.
3) The document reviews the definition, epidemiology, risk factors, diagnosis, management options including PEA surgery outcomes, and evidence for medical therapies of CTEPH.
Acute Stroke protocol of management .. Dina Ashraf (ZUHP team 2012-2013 )
This document discusses several cases involving patients presenting with neurological symptoms. It includes details on the patients' histories, presenting symptoms, vital signs, and test results. The document provides guidance on the assessment and management of these types of cases as a house officer, including taking a history, performing examinations, ordering tests, making treatment decisions, providing supportive care, and monitoring for complications. Key steps outlined are recognizing stroke symptoms, conducting assessments like the NIH stroke scale, obtaining imaging, considering thrombolysis, controlling risk factors, and managing increased intracranial pressure or seizures.
Journals registered with thomson reuters Shared By Abdul Qahar Buneri Abdul W...
Journals registered with thomson reuters Shared By Abdul Qahar Buneri Abdul W...Abdul Qahar {{Abdul Wali Khan University Mardan}} (Buner Campus)
This document lists 57 journals registered with Thomson Reuters and their respective impact factors. The impact factors range from 0.125 to 5.895. Several Pakistani journals are included, such as Pakistan Journal of Zoology, Pakistan Veterinary Journal, and Pakistan Journal of Pharmaceutical Sciences. The journal with the highest impact factor on the list is Academic Medicine, with a factor of 5.895.Pregnancy in ACHD
Massimo Chessa is the head of the Department of Pediatric Cardiology and Adult with Congenital Heart Disease at IRCCS- Policlinico San Donato in Milan, Italy. Congenital heart disease is now considered a lifelong condition due to advances in diagnosis and therapy that have improved survival rates, with more than 75,000-100,000 adults now living with congenital heart disease in Italy. Pregnancy in women with congenital heart disease presents additional hemodynamic challenges and risks that require specialized pre-pregnancy counseling and management.
Approach to cyanotic congenital heart diseases
This document discusses cyanotic congenital heart disease (CCHD), which is defined as a cardiovascular birth defect that results in systemic arterial desaturation due to a right-to-left shunt. CCHDs can be classified based on pulmonary blood flow as having reduced, increased, or near normal flow. Common types of CCHDs with reduced pulmonary blood flow include tetralogy of Fallot and pulmonary atresia. CCHDs with increased pulmonary blood flow can present with features of congestive heart failure. The clinical approach to CCHDs involves delineating the anatomical and physiological abnormalities through assessment of anatomy, pulmonary circulation, systemic circulation, and ventricular function.
Histroy taking in cardiac cases
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ACLS - update and review
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Hiv Concepts Pptvo
Human Immunodeficiency Virus (HIV) is a retrovirus that inserts itself into human cells and reprograms their genetic structure. There is an incubation period before symptoms develop, which can take years. HIV is transmitted through unprotected sexual contact, sharing needles, or from mother to child during birth or breastfeeding. Diagnosis involves antibody and viral load testing. Left untreated, HIV weakens the immune system and increases the risk of infections, cancers, neurological and gastrointestinal issues. Treatment involves antiretroviral therapy to suppress the virus and prevent transmission.
D & C 2012
"Clear!"
7
9.
Shout "Clear!" and press the shock button to deliver the shock.
10. Immediately resume CPR beginning with chest compressions for 2 minutes.
11. Check monitor for rhythm. If still in a shockable rhythm, repeat steps 7-10.
12. If rhythm converts to non-shockable, begin post-resuscitation care.
13. Document all interventions, time, rhythm, response to shocks.
To ensure safety of
caregivers and bystanders
To restore spontaneous
circulation
To determine if additional
shocks are needed
To provide appropriate
care based on patient's
rhythm
Pregnancy hypertension
This document discusses hypertensive disorders of pregnancy, which complicate 5-10% of pregnancies. It defines various types of hypertensive disorders including gestational hypertension, chronic hypertension, preeclampsia, eclampsia, and preeclampsia superimposed on chronic hypertension. It outlines diagnostic criteria and management guidelines for each disorder. Key points covered include definitions, risk factors, complications, treatment and delivery timing based on gestational age. The goal of management is to ensure the safety of the mother and fetus.
Cardiovascular Diagnosis
The document provides information about the anatomy and physiology of the heart, as well as various heart diseases. It describes the internal and external structures of the heart, how the heart pumps blood through the body, and how the heart gets its own blood supply. It then covers topics like the symptoms, signs, and investigations of general heart disease. It discusses specific conditions like coronary artery disease, myocardial infarction, hypertensive heart disease, valvular heart disease, heart failure, congenital heart diseases, heart rhythm disorders, and infectious endocarditis.
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Hypertensive Dyslipidaemics
The document discusses treatment of hypertensive patients who also have dyslipidemia. It describes a case study of a 57-year-old man with prior myocardial infarction, uncontrolled hypertension, and elevated LDL cholesterol. Clinical trials show that intensive statin therapy to achieve lower LDL levels reduces cardiovascular risks more than moderate statin therapy. The Heart Protection Study also found that simvastatin reduced cardiovascular events in high-risk patients, regardless of baseline LDL level.
CKD Presentation PDF
This document provides information on chronic kidney disease (CKD), including its definition, causes, stages, clinical assessment, complications, treatment, and management of associated conditions like hypertension and dyslipidemia. CKD is defined as kidney damage or decreased kidney function lasting 3 months or more. The three most common causes are diabetes, hypertension, and glomerular disease. CKD progresses through five stages depending on kidney damage severity and function level. Treatment focuses on slowing disease progression, managing complications, and reducing cardiovascular risk through blood pressure control, cholesterol lowering, and other measures.
Diabetic nephropathy management
Diabetic nephropathy is a leading cause of end-stage renal disease worldwide. Strict control of blood glucose, blood pressure, angiotensin system inhibitors, and other risk factors can help prevent or slow the progression of kidney damage. The stages include early hyperfiltration, development of microalbuminuria, progression to macroalbuminuria and renal failure. Management focuses on glycemic control, blood pressure reduction, angiotensin blockade, cholesterol control, and management of anemia and cardiovascular risk factors to preserve kidney function for as long as possible.
Chronic Kidney Disease
This document summarizes key topics about chronic kidney disease (CKD), including definitions, classification stages based on glomerular filtration rate (GFR), clinical consequences such as increased cardiovascular risk, and treatment goals like blood pressure and proteinuria control. It discusses markers of renal function like serum creatinine and estimated GFR, as well as complications of CKD like anemia and how they are treated. Target hemoglobin levels with erythropoietin therapy and outcomes of hemodialysis are also summarized.
Antiprotenuric Antihypertensives.pptx
Hypertension is a major public health issue and leading cause of cardiovascular disease globally. It is responsible for about half of heart disease and stroke deaths. The number of hypertensive individuals in India is expected to nearly double by 2025. Chronic kidney disease (CKD) is a major complication of hypertension, with hypertension being the primary cause of end stage renal disease. Strict blood pressure control and use of renin-angiotensin system inhibitors are important for slowing the progression of CKD and reducing proteinuria. Calcium channel blockers, particularly non-dihydropyridine types like cilnidipine, have beneficial effects on renal function through reduction of intraglomerular pressure and antioxidant properties independent of blood pressure
Rational use of blood
Blood transfusion guidelines provide recommendations for appropriate clinical use of blood and components to reduce risks. The risks of transfusion can be lowered through effective donor selection, screening, testing, component separation, storage, and clinical use. Transfusion is recommended when the hemoglobin is less than 7g/dL or the platelet count is less than 10,000/uL, depending on the clinical situation. Alternatives to allogenic transfusion include autologous donation prior to surgery, acute normovolemic hemodilution, erythropoietin, and blood salvage to reduce transfusion needs.
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Diabetic dyslipidemia and Saroglitazar
Dr. Vivek Baliga discusses diabetic dyslipidemia and emerging concepts in its management. Non-HDL cholesterol is a better indicator of cardiovascular risk than LDL cholesterol. It encompasses all potentially atherogenic lipoproteins. Dual PPAR alpha/gamma agonists like saroglitazar can effectively control dyslipidemia and maintain glycemic control in patients with diabetes by reducing triglycerides and non-HDL cholesterol while improving other lipid and glucose parameters. Saroglitazar is approved in India for the treatment of diabetic dyslipidemia.
management of anemia in community setting
anemia is a very common marker of underlying diseases. it's sometimes gone under diagnosed due to lack of knowledge. here's an overview of the different types and causes of anemia and the pharmacists approach in addressing such problem.
Frequency of Anemia and Possible Risk Factors Among Sudanese Children with En...
Frequency of Anemia and Possible Risk Factors Among Sudanese Children with En...CrimsonPublishersBioavailability
Background: Anemia is a common Feature of chronic kidney disease, but the management of anemia in children is complex. Erythropoietin and Supplemental iron are used to maintain hemoglobin levels. The aim of this study to determine the Frequency of anemia and possible Risk Factors Among children with End stage renal disease.
Methods: A total of 96 children, 61males (63.5%) and 35 Females (36.5%), were attended at hemodialysis units in Khartoum state were enrolled in the study and Frequency of anemia was estimated by analyzing CBC on blood counter (sysmex). The concentration of iron profile, C-reactive protein and parathyroid hormone was measured using COBAS INTEGRA 400 PLUS and COBAS E411.
Results: 99% of children were anemic, 4.17% of them were suffering from iron deficiency anemia and there are other causes contributing to anemia in ESRD patients which are inflammation and hyperparathyroidism.
Conclusion: The prevalence of anemia in children on hemodialysis in Sudan appears to be higher than that reported in other studies despite extensive use of rHuEPO and iron supplementation.
ANEMIA IN DIABETES MELLITUS
Anemia is common in patients with diabetes mellitus and chronic kidney disease. Erythropoietin production by the kidneys regulates red blood cell production but is deficient in kidney disease, leading to anemia. Three case studies describe patients with diabetes and various degrees of anemia and kidney impairment. The document discusses the pathogenesis, evaluation, and management of anemia in diabetes, including the role of erythropoietin deficiency and treatment targets. It concludes regular anemia screening and early treatment can help prevent complications in diabetes patients.
Journal Club March 2010
This study tested whether treating anemia in patients with type 2 diabetes and chronic kidney disease using darbepoetin alfa would reduce rates of death and cardiovascular events compared to a placebo. Over 4,000 patients were randomized to receive darbepoetin alfa or placebo, with the goal of maintaining a hemoglobin level of 13.0 g/dL in the treatment group. The study found no significant difference in rates of death, cardiovascular events, or end-stage renal disease between the groups. However, there was an increase in stroke risk observed with darbepoetin alfa treatment.
Dkd new look
1. Diabetic nephropathy is a leading cause of end-stage renal disease. It is defined by progressive albuminuria coupled with increasing blood pressure and declining kidney function.
2. The prevalence and incidence of diabetic nephropathy is increasing worldwide due to rising rates of diabetes. Optimizing blood glucose and blood pressure control can reduce the risk or slow the progression of nephropathy.
3. Standard treatment involves angiotensin-converting enzyme inhibitors or angiotensin receptor blockers to control blood pressure and slow kidney function decline, though current therapies only slow progression and do not halt it. Additional research is still needed to develop more effective treatments.
final.pptx
This patient is a 55-year-old male with uncontrolled hypertension, uncontrolled type 2 diabetes, stage 1 chronic kidney disease, and dyslipidemia who presents with fatigue, headaches, and erectile dysfunction. His medical history and lab results indicate high cardiovascular risk. The treatment plan involves lifestyle modifications, optimizing medications to better control his blood pressure and blood glucose, and monitoring by a multidisciplinary team to reduce complications.
Blood transfusion
This document discusses guidelines for blood transfusion. It begins by stating the aims of maximizing patient safety by helping clinicians decide when transfusion is appropriate and minimizing avoidable risks. It then discusses that the risks of transfusion are very low at 1 in 12,000 and there is no documented transmission of variant CJD or high risks of viruses. The document provides guidance on appropriate transfusion thresholds and alternatives to transfusion such as autologous donation, erythropoietin, acute normovolaemic haemodilution, and discusses complications and risks of not transfusing.
Chronic kidney disease
This document provides an overview of chronic kidney disease (CKD), including definitions, stages, methods for measuring glomerular filtration rate and proteinuria, risk factors for progression, complications, and management strategies. Key points covered include defining and staging CKD, estimating GFR using creatinine clearance and the MDRD equation, screening for and treating anemia, hypertension, hyperlipidemia, renal osteodystrophy, and acidosis, and preparing patients for end-stage renal disease with timely nephrology referrals and vascular access placement.
Cruz C, Cruz LS Nephron Clinic Pract
This study examined the incidence and predictors of acute renal failure (ARF) in congestive heart failure (CHF) patients treated with angiotensin-converting enzyme inhibitors (ACEIs). The researchers followed 114 CHF patients treated with ACEIs over 30 days. They found that 25% developed ARF, 15% developed hyperkalemia, and 3% developed severe hyperkalemia. Predictors of ARF included a decrease in average blood pressure of 25 mm Hg or more after starting ACEI treatment, class IV CHF, diabetes, and hypertension. A decrease in blood pressure of 25 mm Hg or more and class IV CHF were independent predictors of ARF based on multivariate analysis.
Dkd
DKD is a leading cause of ESRD in the US, affecting 30-40% of those with diabetes. Poor glycemic control and hypertension are major risk factors for developing and progressing DKD. Clinical trials have shown that intensive control of blood glucose and blood pressure can delay and prevent kidney disease. New drugs targeting the kidney are showing promise in reducing albuminuria and slowing kidney function decline in DKD patients.
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Frequency of Anemia and Possible Risk Factors Among Sudanese Children with En...
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Brief Review Of Chemotherapeutic Agents And Renal Failure
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- 1. Anemia in CKD Part 2 of 2 Division of Nephrology and Hypertension East Carolina University Brody School of Medicine
- 9. The Prevalence of Anemia in CKD Curr Med Res Opin. 2004;20:1501-1510 .
Editor's Notes
- Creatinine clearance used to be the most commonly used estimation of GFR. You measure the amount of creatinine that is cleared from the plasma in a given time period. Cr clearance overestimates GFR because it is secreted into the tubular lumen in addition to being freely filtered. The formula to remember is UV/P Normal is 100-140cc/min and women may have a slightly lower clearance depending on muscle mass.
- This figure from Wm McClellan’s PAERI study demonstrates that the prevalence of anemia is strongly associated with the severity of CKD among 5000 CKD patient none of whom were receiving erythropoeitin. PAERI Study: Prospective, multicenter, cross-sectional study Primary care offices CKD: Scr 2-6 mg/dL men; 1.5-6 mg/dL women 5222 patients evaluated -mean age 68.2 years; ~54% female; ~23% black Mean Ccr 39.1 (~35% had Ccr < = 30 mL/min; n=5171) ~39% had Hb >10 g/dL but <=12; ~9% had a Hb <=10 g/dL (n=5171) Women, diabetics, blacks and Hispanics were more likely to have a Hb <=12 g/dL At Ccr of <= 15, ~76% of patients had a Hb <= 12 g/dL and ~30% had a Hb <= 10 g/dL (n=172) A Ccr reduction of 10 mL/min was associated with a 23% increased odds of having a Hb <= 12 g/dL and a 35% increased odds of having a Hb <= 10 g/dL. AS COMPARED TO: 15,000 participants in the NHANES study Prevalence of anemia: 1% at an eGFR of 60cc/min per 1.73 m2 9% at an eGFR of 30cc/min per 1.73 m2 33-67% at an eGFR of 15cc/min per 1.73 m2
- Creatinine clearance used to be the most commonly used estimation of GFR. You measure the amount of creatinine that is cleared from the plasma in a given time period. Cr clearance overestimates GFR because it is secreted into the tubular lumen in addition to being freely filtered. The formula to remember is UV/P Normal is 100-140cc/min and women may have a slightly lower clearance depending on muscle mass.