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Acute renal insufficiency

Hiroyuki Yamada, Kent Doi, Tatsuo Tsukamoto, Hideyasu Kiyomoto, Kazuto Yamashita, Motoko Yanagita, Yoshio Terada, Kiyoshi Mori
BACKGROUND: Theoretically, atrial natriuretic peptide (ANP), especially low-dose ANP, is beneficial in acute kidney injury (AKI). In this study, we examined whether low-dose ANP is effective in preventing or treating AKI by conducting an updated systematic review for randomized controlled trials (RCTs). METHOD: We searched the Excerpta Medica database (EMBASE), PubMed, and Cochrane CENTRAL databases for RCTs that compare the effects of low-dose ANP (≤ 50 ng/kg/min) with a placebo or conventional therapy in at-risk patients or patients with AKI...
February 11, 2019: Critical Care: the Official Journal of the Critical Care Forum
Morcos Atef Awad, Lawrence S C Czer, Dominic Emerson, Stanley Jordan, Michele A De Robertis, James Mirocha, Evan Kransdorf, David H Chang, Jignesh Patel, Michelle Kittleson, Danny Ramzy, Joshua S Chung, J Louis Cohen, Fardad Esmailian, Alfredo Trento, Jon A Kobashigawa
Background Combined heart and kidney transplantation ( HKT x) is performed in patients with severe heart failure and advanced renal insufficiency. We analyzed the long-term survival after HKT x, the influence of age and dialysis status, the rates of cardiac rejection, and the influence of sensitization. Methods and Results From June 1992 to December 2016, we performed 100 HKT x procedures. We compared older (≥60 years, n=53) with younger (<60 years, n=47) recipients, and recipients on preoperative dialysis (n=49) and not on dialysis (n=51)...
February 19, 2019: Journal of the American Heart Association
Kevin Schlidt, Andrew Kadlec, Sanjay Bhandari, Pinky Jha
Cefepime is a fourth-generation cephalosporin widely used to treat gram-positive and gram-negative infections. Its half-life is approximately two hours in patients with normal renal function and may increase to 13.5 hours in patients with acutely or chronically impaired renal function. Although dosage adjustment is recommended for patients with renal insufficiency to prevent drug accumulation, toxicity has been reported in patients even with normal renal function. One underreported complication of cefepime toxicity is cefepime-induced encephalopathy (CIE)...
November 30, 2018: Curēus
Bo Yang, Elizabeth L Norton, Reilly Hobbs, Linda Farhat, Xiaoting Wu, Whitney E Hornsby, Karen M Kim, Himanshu J Patel, G Michael Deeb
OBJECTIVE: The study objective was to evaluate the perioperative and long-term outcomes of aortic root repair and aortic root replacement and provide evidence for root management in acute type A aortic dissection. METHODS: From 1996 to 2017, 491 patients underwent aortic root repair (n = 307) or aortic root replacement (n = 184) (62% bioprosthesis) for acute type A aortic dissection. Indications for aortic root replacement were intimal tear at the aortic root, root measuring 4...
December 21, 2018: Journal of Thoracic and Cardiovascular Surgery
Tong Chen, Peng-Cheng Xu, Shui-Yi Hu, Tie-Kun Yan, Jian-Qing Jiang, Jun-Ya Jia, Li Wei, Wen-Ya Shang
RATIONALE: Angiotensin receptor blocker (ARB) can increase serum creatinine or potassium levels in patients with renal insufficiency, renal artery stenosis, heart failure or hypovolemia, but hardly cause severe kidney injury in patients without any risk factors. A case of severe acute interstitial nephritis (AIN) induced by valsartan was reported here. PATIENT CONCERNS: A 62-year-old female with nausea for 1 month and acute deterioration of kidney function for 2 weeks was admitted...
February 2019: Medicine (Baltimore)
Evan R Zynda, Mitchell H Maloy, Eugene S Kandel
Kidney ischemia, characterized by insufficient supply of oxygen and nutrients to renal epithelial cells, is the main cause of acute kidney injury and an important contributor to mortality world-wide. Earlier research implicated a G-protein coupled receptor (NK1R) in the death of kidney epithelial cells in ischemia-like conditions. P21-associated kinase 1 (PAK1) is involved in signalling by several G-proteins. We explored the consequences of PAK1 inhibition for cell survival under the conditions of reduced glucose and oxygen...
February 6, 2019: Cell Cycle
Tanmay Gaglani, Catherine H Davis, Harold R Bailey, Marianne V Cusick
BACKGROUND: The relapsing and remitting nature of inflammatory bowel disease (IBD) predisposes patients to the development of fibrotic strictures, which must often be managed surgically. Laparoscopy provides the potential for enhanced perioperative care. Previous studies comparing morbidity and trends of open versus laparoscopic resection have been constrained by length of study and sample size. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program database, patients with primary diagnosis of IBD undergoing surgical resection from 2005 to 2015 were identified...
March 2019: Journal of Surgical Research
Xin Huang, Björn Redfors, Shmuel Chen, Bernard J Gersh, Roxana Mehran, Yiran Zhang, Thomas McAndrew, Ori Ben-Yehuda, Gary S Mintz, Gregg W Stone
OBJECTIVES: We sought to identify clinical, electrocardiographic (ECG), and angiographic characteristics that are predictive of 3-year mortality after primary percutaneous coronary intervention (PCI) in patients with non-anterior ST-elevation myocardial infarction (NA-STEMI) from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial. BACKGROUND: Which patients with NA-STEMI undergoing PCI have a poor prognosis is uncertain...
January 28, 2019: Catheterization and Cardiovascular Interventions
B V K S Lakkakula
Sickle cell disease (SCD) is considered as a vascular disease due to its chronic vascular manifestations such as leg ulcers, priapism, acute chest syndrome (ACS), stroke, retinopathy, renal insufficiency, pulmonary hypertension, avascular necrosis of the femoral head (AVNF) and splenic infarction. Emerging evidence has shown that the MTHFR 677C>T variant allele is associated with vascular complications (VC) in patients with SCD; however, results from individual studies are inconclusive. The aim of this meta-analysis is to evaluate the association between the MTHFR 677C>T polymorphism and the susceptibility for VC in SCD patients...
January 10, 2019: Transfusion Clinique et Biologique: Journal de la Société Française de Transfusion Sanguine
Jung Sun Lee, Oh Chan Kwon, Ji Seon Oh, Yong-Gil Kim, Chang-Keun Lee, Bin Yoo, Seokchan Hong
Background/Aims: A substantial portion of gout patients have normal serum urate levels during an acute attack but data on the clinical characteristics and risk of recurrence compared with hyperuricemic patients are limited. Methods: In this retrospective cohort study, clinical features of normouricemic and hyperuricemic patients were compared. Multivariate analysis was performed to determine whether normouricemic patients were less likely to have a recurrent attack...
January 28, 2019: Korean Journal of Internal Medicine
Vincent Piller, Patrick Jarlborg, Pierre-Henri Morère
Contrast induced nephropathy has long been considered as the third cause of inpatients acute renal insufficiency after functional renal insufficiency and acute tubular necrosis. This entity is now controversial. Numerous studies failed to show a direct link between intravenous iodinated contrast injection and a worsening of renal function after injected scanners in patients with normal renal function. The notion of contrast induced nephropathy remains integrated in the practice of the majority of physicians, who often overestimate this risk...
January 23, 2019: Revue Médicale Suisse
Frederick A Waldron, Irina Benenson, Shelley A Jones-Dillon, Shreni N Zinzuwadia, Adedamola M Adeboye, Ela Eris, Nkechi E Mbadugha, Natali Vicente, Alexandra Over
PURPOSE: A 3-year case control study was conducted to determine the prevalence of hypertensive crisis and its subtypes, hypertensive emergency and hypertensive urgency. The secondary objectives were to identify risk factors for hypertensive emergencies and to determine the odds of developing acute target organ damage among predominantly African American patients with a confirmed diagnosis of hypertension. MATERIALS AND METHODS: Using emergency department medical records, patients with a confirmed diagnosis of hypertension were identified...
January 22, 2019: Blood Pressure
Andrew G Wu, Uzma Samadani, Tina M Slusher, Lei Zhang, Andrew W Kiragu
OBJECTIVE: To explore the effect of 23.4% hypertonic saline for management of elevated intracranial pressure in children admitted to our institution for severe traumatic brain injury. DESIGN: Single-center, retrospective medical chart analysis. SETTING: A PICU at a level 1 pediatric trauma center in the United States. PATIENTS: Children admitted for severe traumatic brain injury from 2006 to 2016 who received 23.4% hypertonic saline and whose intracranial pressures were measured within 5 hours of receiving 23...
January 18, 2019: Pediatric Critical Care Medicine
Laura Lladó, Ana González-Castillo, Joan Fabregat, Carme Baliellas, Emilio Ramos, Emma González-Vilatarsana, Juli Busquets, Xavier Xiol
BACKGROUND Delaying initiation of tacrolimus after liver transplantation (LT) is a potential renal-sparing strategy. We assessed safety and efficacy of delayed initiation of prolonged-release tacrolimus (PR-T) in de novo LT. MATERIAL AND METHODS This was a single-center, single-arm, prospective, 12-month observational study of hepatitis C virus-negative orthotopic LT patients. Immunosuppression included PR-T (initially 0.1 or 0.2 mg/kg/day) initiated on Day 3 post LT, basiliximab (20 mg) on post-transplantation Day 0 and Day 4, and intraoperative corticosteroids (500 mg)...
January 18, 2019: Annals of Transplantation: Quarterly of the Polish Transplantation Society
Zhiwei Li, Guoliang Fan, Xiaorong Zheng, Xiaowen Gong, Tienan Chen, Xiaocheng Liu, Kegang Jia
OBJECTIVES: Our goal was to investigate risk factors for acute kidney injury (AKI) after coronary artery bypass grafting (CABG) and the impact of AKI on short-term outcomes. METHODS: Data on 1395 patients (1261 who had isolated CABG and 134 with other operations) who underwent non-emergent CABG from January 2013 to March 2016 were retrospectively collected from a single centre. Logistic regression was performed to analyse risk factors. Cox regression was used to analyse the impact of AKI on the postoperative 30-day death rate...
January 16, 2019: Interactive Cardiovascular and Thoracic Surgery
Douglas J Weaver, Azeem Tariq Malik, Nikhil Jain, Elizabeth Yu, Jeffery Kim, Safdar N Khan
BACKGROUND: The modified 5-item frailty index (mFI-5) is a concise co-morbidity based risk stratification tool that has been shown to predict the occurrence of adverse outcomes following various orthopaedic surgeries. METHODS: The 2012-2016 American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) dataset was used to identify patients undergoing an elective 1-to-2 level posterior lumbar fusion for degenerative lumbar pathology. The mFI-5 score was calculated on the basis of the presence of the five co-morbidities - congestive heart failure within 30 days prior to surgery, insulin-dependent or non-insulin dependent diabetes mellitus, chronic obstructive pulmonary disease or pneumonia, partially dependent or totally dependent functional health status at time of surgery and hypertension requiring medication...
January 10, 2019: World Neurosurgery
Nara Thaisa Tenório Martins Braga, Adriana Banhos Carneiro, Kathia Liliane da Cunha Ribeiro Zuntini, Flávio Bezerra de Araújo, Elizabeth De Francesco Daher
Takayasu arteritis (TA) is a chronic granulomatous inflammatory condition of unknown cause that involves large vessels - particularly the aorta and its branches - such as the carotid, coronary, pulmonary, and renal arteries. The left subclavian artery is the most frequently involved vessel. Stenosis of the renal artery has been reported in 23-31% of the cases and may result in malignant hypertension, ischemic renal disease, decompensated heart failure, and premature death. Involvement of both renal arteries is uncommon...
January 10, 2019: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
Sida Jia, Yanyan Zhao, Jingang Yang, Xueyan Zhao, Haiyan Xu, Runlin Gao, Qingsheng Wang, Junnong Li, Jinqing Yuan, Yuejin Yang
OBJECTIVE: To explore the relationship between inhospital outcomes and different estimated glomerular filtration rates (eGFRs) and determine an optimal eGFR cutoff value for predicting risk in patients with renal insufficiency (RI). BACKGROUND: RI is a predictor of poor prognosis in patients with myocardial infarction undergoing primary percutaneous coronary intervention (PCI). However, the cutoff value of the eGFR is questionable. METHODS: We included 10,240 patients with ST segment elevation myocardial infarction (STEMI) undergoing primary PCI from January 2013 to January 2016 who participated in the China Acute Myocardial Infarction registry...
January 13, 2019: Catheterization and Cardiovascular Interventions
James Cranley, Unni Krishnan, Katharine Tweed, Rudolf Martin Duehmke
A 51-year-old woman with known primary antiphospholipid syndrome presented with a 4-day history of chest and abdominal pain, inferior ST-segment elevation on a 12-lead ECG and a subtherapeutic international normalised ratio. In view of a significantly raised high-sensitivity troponin I assay, inferior wall hypokinesis on transthoracic echocardiography and despite unobstructed epicardial vessels on emergency coronary angiography, a diagnosis of myocardial infarction was made. Furthermore, the patient also developed both bilateral adrenal haemorrhages leading to acute adrenal insufficiency and microvascular thrombotic renal disease concurrently...
January 10, 2019: BMJ Case Reports
Tomohiko Yamamoto, Shin-Ichiro Miura, Kazuyuki Shirai, Hidenori Urata
Background: While reduction of accumulated body fluid using loop diuretics is a commonly used therapeutic option for acute heart failure (AHF), some patients, especially those with chronic kidney disease (CKD), show significantly poor treatment response to loop diuretics. Tolvaptan (TLV) has shown effectiveness against AHF in several studies. We have been using TLV for AHF treatment, and it displayed favorable outcome even in patients with CKD. This study aimed to assess the therapeutic effectiveness of TLV in AHF patients...
January 2019: Journal of Clinical Medicine Research
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