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Hypokalemia renal transplant

Carlos G Musso, Alejandrina Castañeda, María Giordani, Cesar Mombelli, Silvia Groppa, Nora Imperiali, Guillermo Rosa Diez
Kidney transplant patients (KTPs), and particularly those with advanced chronic kidney rejection, may be affected by opportunistic infections, metabolic alterations and vascular and oncologic diseases that promote clinical conditions that require a variety of treatments, the combinations of which may predispose them to hyponatremia. Salt and water imbalance can induce abnormalities in volemia and/or serum sodium depending on the nature of this alteration (increase or decrease), its absolute magnitude (mild or severe) and its relative magnitude (body sodium:water ratio)...
August 2018: Clinical Kidney Journal
Hiroyuki Yamazaki, Tadakazu Kondo, Kazunai Aoki, Kouhei Yamashita, Akifumi Takaori-Kondo
Liposomal amphotericin B (L-AMB) has the potential to cause two major adverse events, renal dysfunction and serum potassium abnormality; however, appropriate clinical management of these events remains unclear. We retrospectively analyzed data regarding 128 hematology patients who received L-AMB in our institute and examined the association between clinical characteristics and renal dysfunction or serum potassium abnormality. We found that the median weight-normalized dose of L-AMB was 2.69mg/kg and the median administration period was 16days...
February 2018: Diagnostic Microbiology and Infectious Disease
Marie de Tersant, Thérésa Kwon, Marie-Alice Macher, Anne Maisin, Georges Deschênes, Olivier Niel
BACKGROUND: Acute pancreatitis can be a life-threatening complication in patients with chronic kidney disease (CKD), especially in kidney transplant recipients. CASE DIAGNOSIS/TREATMENT: The patient was 7 years old when he received renal transplantation for CKD secondary to posterior urethral valves. Two years later, he presented with severe necrotizing pancreatitis (Ranson's score 5, Balthazar's score 8). Viral and genetic testing came back negative; pancreatitis was attributed to the patient's treatments (prednisone, trimethoprim-sulfamethoxazole, and everolimus)...
July 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Halima Gottfriedová, Miroslava Horáčková, Milena Čáslavská, Julius Špičák, Otto Schück
In patients with advanced cirrhosis with ascites disorders of water and electrolyte metabolism are often present and they are associated with changes in acid-base balance. These changes can be very complicated, their diagnosis and treatment difficult. Dilutional hyponatremia is the most common disorder. Hyponatremia in these patients is associated with increased morbidity and mortality before and after liver transplantation. Other common disorders include hyperchloremic acidosis, hypokalemia, metabolic alkalosis, lactic acidosis, respiratory alkalosis...
2017: Casopís Lékar̆ů C̆eských
Jung Ju Choi, Yong Beom Kim, Hong Soon Kim, Kyung Cheon Lee, Youn Yi Jo
INTRODUCTION: Profound metabolic alkalosis is an uncommon consideration for the anesthetic management of kidney transplantation. Serum total carbon dioxide content and complex electrolyte abnormalities might be important diagnostic clues for the presence of metabolic alkalosis in the absence of arterial blood gas analysis. CASE PRESENTATION: A 34-year-old female visited Gachon University Gil Medical Center, Incheon, South Korea during year 2015. She experienced aggravated renal function due to chronic hypokalemia and severe hypochloremic metabolic alkalosis, induced by laxative abuse, and underwent ABO incompatible kidney transplantation...
November 2016: Iranian Red Crescent Medical Journal
Francesco Rapisarda, Grazia Portale, Silvia Ferrario, Concetto Sessa, Roberta Aliotta, Luca Zanoli, Pasquale Fatuzzo
In contrast to other ions, magnesium is treated as an orphan by the body: there are no hormones that have a substantial role in regulating urinary magnesium excretion, and bone, the principal reservoir of magnesium, does not readily exchange with circulating magnesium.The Mg ++ is often overlooked by physicians in the differential diagnosis because it is considered insignificant, but its role is crucial for cells function, first of all neurons and cardiomyocytes. A condition of hypocalcemia associated with hypokalemia, especially in the presence of chronic renal failure, should raise suspicion of a lack of Mg ++...
January 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Maryam Razzaghy-Azar, Mabel Yau, Ahmed Khattab, Maria I New
Apparent mineralocorticoid excess (AME) is a genetic disorder causing severe hypertension, hypokalemia, and hyporeninemic hypoaldosteronism owing to deficient 11 beta-hydroxysteroid dehydrogenase type-2 (11βHSD2) enzyme activity. The 11βHSD2 enzyme confers mineralocorticoid receptor specificity for aldosterone by converting cortisol to its inactive metabolite, cortisone and inactivating the cortisol-mineralocorticoid receptor complex. The 20year follow-up of a consanguineous Iranian family with three sibs affected with AME shows the successes and pitfalls of medical therapy with spironolactone...
January 2017: Journal of Steroid Biochemistry and Molecular Biology
Hongfeng Huang, Wenqing Xie, Jianyong Wu, Ying Xu, Xianping Yu, Pingping Ren, Jianghua Chen
OBJECTIVE: To explore the efficacy and safety of designed early conversion from calcineurin inhibitor (CNI) to sirolimus (SRL) as major immunosuppressive therapy in renal transplant recipients with stable renal function. METHODS: A prospective, open-label and non-randomized control study was performed for 112 renal transplant recipients (3-6 months post-operation) with stable renal function between June 2008 and June 2011. The patients in SRL group (n = 57) switched to sirolimus while those in CNI group (n = 55) continued CNI...
November 18, 2014: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Maddalena Giannella, Giorgio Ercolani, Francesco Cristini, Mariacristina Morelli, Michele Bartoletti, Valentina Bertuzzo, Sara Tedeschi, Stefano Faenza, Cristina Puggioli, Russell E Lewis, Antonio Daniele Pinna, Pierluigi Viale
BACKGROUND: To assess the safety and tolerability of high-dose weekly (10 mg/kg) liposomal amphotericin B (LamB) for antifungal prophylaxis in liver transplantation (LT) recipients with predefined risk factors for invasive fungal infection (IFI), a prospective phase II noncomparative trial was performed at our center over a 4-year period. METHODS: In the selected LT recipients, LamB was administered weekly until hospital discharge after LT for minimum 2 weeks. Criteria for early discontinuing prophylaxis were: (i) any adverse event (AE); (ii) suspicion of IFI...
April 2015: Transplantation
Ioana Mozos
Sudden cardiac death continues to be a major public health problem. Ventricular arrhythmia is a main cause of sudden cardiac death. The present review addresses the links between renal function tests, several laboratory markers, and ventricular arrhythmia risk in patients with renal disease, undergoing or not hemodialysis or renal transplant, focusing on recent clinical studies. Therapy of hypokalemia, hypocalcemia, and hypomagnesemia should be an emergency and performed simultaneously under electrocardiographic monitoring in patients with renal failure...
2014: BioMed Research International
Justine Bacchetta, Odile Basmaison, Anne-Laure Leclerc, Aurélia Bertholet-Thomas, Pierre Cochat, Bruno Ranchin
BACKGROUND: The management of tubulopathies after renal transplantation (RTx) may require high doses of sodium and bicarbonate, reducing the quality of life and therapeutic compliance of the patient. Some studies on adult patients have highlighted the benefits of fludrocortisone (fludro) in the treatment of severe tubulopathies. METHODS: This study was a retrospective review of the medical charts of 15 children, aged 12.4 (range 3.6-17.4) years who received fludro after RTx...
October 2014: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Jennifer A Frontera
Hepatic encephalopathy management varies depending on the acuity of liver failure. However, in patients with either acute or chronic liver failure five basic steps in management are critical: stabilization, addressing modifiable precipitating factors, lowering blood ammonia, managing elevated intracranial pressure (ICP) (if present), and managing complications of liver failure that can contribute to encephalopathy, particularly hyponatremia. Because liver failure patients are prone to a variety of other medical problems that can lead to encephalopathy (such as coagulopathy associated intracranial hemorrhage, electrolyte disarray, renal failure, hypotension, hypoglycemia, and infection), a thorough history, physical and neurologic examination is mandated in all encephalopathic liver failure patients...
June 2014: Current Treatment Options in Neurology
Dominique Chauveau, Stanislas Faguer, Flavio Bandin, Vincent Guigonis, Nicolas Chassaing, Stéphane Decramer
HNF1B encodes for a transcription factor involved in the early development of the kidney, pancreas, liver and genital tract. Mutations in HNF1B are dominantly inherited and consist of whole-gene deletion, or small mutation. De novo mutation occurs in half of tested kindreds. HNF1B-related disease combines renal and non-renal manifestations. Renal involvement is heterogeneous and may escape early recognition. During fetal life and childhood, it mostly consists of hyperechogenic kidneys or bilateral renal cystic hypodysplasia...
November 2013: Néphrologie & Thérapeutique
David J Taber, Titte M Srinivas, Nicole A Pilch, Holly B Meadows, James N Fleming, John W McGillicuddy, Charles F Bratton, Beje Thomas, Kenneth D Chavin, Prabhakar K Baliga, Leonard E Egede
BACKGROUND/AIMS: There are no published studies assessing the safety and efficacy of thiazides as antihypertensives in kidney transplantation (KTX). METHODS: This was a longitudinal retrospective cohort study conducted in adult KTX recipients. Patients were grouped based on receiving thiazides following KTX. Safety and efficacy comparisons were made between thiazide recipients and unexposed patients, as well as change in blood pressure (BP) within thiazide patients...
2013: American Journal of Nephrology
Behzad Einollahi, Mojtaba Teimoori, Zohreh Rostami
BACKGROUND: Although the immunosuppressant cyclosporine (CsA) is widely used after kidney transplantation over the long term, there is still no firm consensus on the best way to monitor of CsA blood levels. OBJECTIVES: Cyclosporine (CsA) assay is critical for the management of renal transplant recipients due to inter- and intra-patient variation in CsA absorption and metabolism. PATIENTS AND METHODS: In a retrospective cross sectional study, blood levels of CsA (through and 2 hours post dose) measured at least 5 times during 3 years post transplantation, in 7702 kidney transplant recipients from different transplant center of Tehran, IR Iran between 2008 and 2012...
2012: Nephro-urology Monthly
K Fidan, Y Kandur, H Sozen, I I Gonul, A Dalgic, O Söylemezoğlu
We analyzed 25 pediatric renal transplantation patients on sirolimus (SRL) therapy to assess changes in serum creatinine, glomerular filtration rate, electrolytes, triglycerides, cholesterol, and side effects. Mean time to initiate SRL therapy was 3.2 years. The serum creatinine levels of patients on SRL treatment at 1, 6, 12, and 24 months were 1.67 ± 1.15 mg/dL, 1.18 ± 0.52 mg/dL, 1.24 ± 0.32 mg/dL, 1.15 ± 0.31 mg/dL, and 1.17 ± 0.12 mg/dL, respectively. We observed proteinuria in 3, hyperlipidemia in 5, and anemia in 2 patients, but none had the treatment discontinued...
January 2013: Transplantation Proceedings
Hans-Henrik Parving, Barry M Brenner, John J V McMurray, Dick de Zeeuw, Steven M Haffner, Scott D Solomon, Nish Chaturvedi, Frederik Persson, Akshay S Desai, Maria Nicolaides, Alexia Richard, Zhihua Xiang, Patrick Brunel, Marc A Pfeffer
BACKGROUND: This study was undertaken to determine whether use of the direct renin inhibitor aliskiren would reduce cardiovascular and renal events in patients with type 2 diabetes and chronic kidney disease, cardiovascular disease, or both. METHODS: In a double-blind fashion, we randomly assigned 8561 patients to aliskiren (300 mg daily) or placebo as an adjunct to an angiotensin-converting-enzyme inhibitor or an angiotensin-receptor blocker. The primary end point was a composite of the time to cardiovascular death or a first occurrence of cardiac arrest with resuscitation; nonfatal myocardial infarction; nonfatal stroke; unplanned hospitalization for heart failure; end-stage renal disease, death attributable to kidney failure, or the need for renal-replacement therapy with no dialysis or transplantation available or initiated; or doubling of the baseline serum creatinine level...
December 6, 2012: New England Journal of Medicine
Shinsuke Noguchi, Naoto Takahashi, Mitsugu Ito, Kazuaki Teshima, Takaya Yamashita, Yoshihiro Michishita, Hideaki Ohyagi, Seiji Shida, Takayo Nagao, Masumi Fujishima, Sho Ikeda, Isuzu Ito, Naohito Fujishima, Yoshihiro Kameoka, Hirobumi Saitoh, Hiroyuki Tagawa, Makoto Hirokawa, Kenichi Sawada
BACKGROUND: Liposomal amphotericin B (L-AmB) is recommended as an empirical antifungal treatment for patients at increased risk of fungal infections although renal toxicity remains a clinical problem. We therefore conducted a pilot study to evaluate the safety and efficacy of low-dose L-AmB as an empirical antifungal therapy for patients with prolonged neutropenia. METHODS: High-risk patients with hematological malignancies were eligible to enroll in this study provided they had: exhibited neutropenia for at least 1 week; suffered from high-grade fever for 4 days despite treatment with a broad-spectrum antibacterial; and no identified fever-causing pathogen...
December 2013: International Journal of Clinical Oncology
Ozkan Gungor, Fatih Kircelli, Juan Jesus Carrero, Ender Hur, Hamad Dheir, Adnan Simsir, Firat Okmen, Huseyin Toz, Cuneyt Hoscoskun
Congenital adrenal hyperplasia belongs to a group of autosomal recessive disorders affecting steroid biosynthesis; a rare disease with a prevalence of 1 case per 16,000 population. A 30-year-old phenotypically male patient had been diagnosed with 11-β hydroxylase deficiency at the age of 16; presenting with ambiguous genitalia, growth retardation, presence of menstrual cycles, severe hypertension, hypokalemia and renal dysfunction. He developed endstage renal disease due to hypertension and was treated with hemodialysis for 3 y...
August 2012: Clinical Nephrology
Dongmei Chen, Zheng Tang, Chunlei Luo, Huiping Chen, Zhihong Liu
AIM: To study the clinical and pathological characteristics of aristolochic acid nephropathy (AAN). METHODS: 86 patients with AAN during 2001 and 2009 in our department were recruited in this retrospective study. The clinical and pathological features were analyzed. RESULTS: There were 47 males and 39 females, aging from 12 to 69 years old. Abnormal urine analysis and gastro-intestinal diseases were two main underlying causes for patients taking aristolochic acid (AA) containing drugs...
July 2012: Clinical Nephrology
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