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Nephrology critical care

Mohamed A Osman, Mona Alrukhaimi, Gloria E Ashuntantang, Ezequiel Bellorin-Font, Mohammed Benghanem Gharbi, Branko Braam, Mark Courtney, John Feehally, David C Harris, Vivekanand Jha, Kailash Jindal, David W Johnson, Kamyar Kalantar-Zadeh, Rumeyza Kazancioglu, Scott Klarenbach, Adeera Levin, Meaghan Lunney, Ikechi G Okpechi, Timothy Olusegun Olanrewaju, Jeffrey Perl, Harun Ur Rashid, Eric Rondeau, Babatunde Lawal Salako, Arian Samimi, Laura Sola, Irma Tchokhonelidze, Natasha Wiebe, Chih-Wei Yang, Feng Ye, Alexander Zemchenkov, Ming-Hui Zhao, Aminu K Bello
The health workforce is the cornerstone of any health care system. An adequately trained and sufficiently staffed workforce is essential to reach universal health coverage. In particular, a nephrology workforce is critical to meet the growing worldwide burden of kidney disease. Despite some attempts, the global nephrology workforce and training capacity remains widely unknown. This multinational cross-sectional survey was part of the Global Kidney Health Atlas project, a new initiative administered by the International Society of Nephrology (ISN)...
February 2018: Kidney International Supplements
P S Priyamvada, R Jayasurya, Vijay Shankar, S Parameswaran
There is only limited information on the epidemiology and outcomes of acute kidney injury (AKI) in critically ill patients from low- and middle-income countries. This study aims to identify the etiology, short-term outcomes, and determinants of mortality in patients with AKI admitted to multiple medical and surgical Intensive Care Units (ICU's) in a tertiary care center. The study also aims to compare the clinical characteristics and outcomes of community-acquired AKI (CAAKI) and hospital-acquired AKI (HAAKI)...
November 2018: Indian Journal of Nephrology
Amanda M Uber, Scott M Sutherland
Over the past decade, the nephrology and critical care communities have adopted a consensus approach to diagnosing acute kidney injury (AKI) and, as a result, we have seen transformative changes in our understanding of pediatric AKI epidemiology. The data regarding outcomes among neonates and children who develop AKI have become far more robust and AKI has been clearly linked with an increased need for mechanical ventilation, longer inpatient stays, and higher mortality. Though AKI was historically thought to be self-limited, we now know that renal recovery is far from universal, particularly when AKI is severe; the absence of recovery from AKI also carries longitudinal prognostic implications...
November 1, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Alyssa A Riley, Mary Watson, Carolyn Smith, Danielle Guffey, Charles G Minard, Helen Currier, Ayse Akcan Arikan
BACKGROUND: To evaluate changes in population characteristics and outcomes in a large single-center pediatric patient cohort treated with continuous renal replacement therapy (CRRT) over a 10 year course, coincident with multiple institutional practice changes in CRRT delivery. METHODS: A retrospective cohort study with comparative analysis of all patients treated from 2004 to 2013 with CRRT in the neonatal, pediatric, and cardiovascular intensive care units within a free-standing pediatric tertiary care hospital...
October 19, 2018: BMC Nephrology
Linda C Kelahan, Terry S Desser, Megan L Troxell, Aya Kamaya
Ultrasound assessment of the kidneys in patients with renal impairment has been described in various ways in the critical care, nephrology, and radiology literature, resulting in a somewhat heterogeneous picture of the gray-scale and Doppler ultrasound manifestation of acute kidney injury (AKI). Given that ultrasound assessment can potentially identify reversible causes of AKI or identify underlying chronic kidney disease, it is important for radiologists to be aware of the common etiologies of AKI and the spectrum of ultrasound findings...
October 8, 2018: Ultrasound Quarterly
Angela Ju, Michelle A Josephson, Zeeshan Butt, Sheila Jowsey-Gregoire, Jane Tan, Quinetta Taylor, Kevin Fowler, Fabienne Dobbels, Fergus Caskey, Vivekanand Jha, Jayme Locke, Greg Knoll, Curie Ahn, Camilla S Hanson, Benedicte Sautenet, Karine Manera, Jonathan C Craig, Martin Howell, Claudia Rutherford, Allison Tong
BACKGROUND: Kidney transplantation confers substantial survival and quality of life benefits for many patients with end-stage kidney disease compared with dialysis, but complications and side-effects of immunosuppression can impair participation in daily life activities. Life participation is a critically important patient-reported outcome for kidney transplant recipients but is infrequently and inconsistently measured in trials. We convened a consensus workshop on establishing an outcome measure for life participation for use in all trials in kidney transplantation...
October 8, 2018: Transplantation
Adrianna Douvris, Khalid Zeid, Swapnil Hiremath, Pierre Antoine Brown, Manish M Sood, Rima Abou Arkoub, Gurpreet Malhi, Edward G Clark
Background: Safety lapses in hospitalized patients with acute kidney injury (AKI) may lead to hemodialysis (HD) being required before renal recovery might have otherwise occurred. We sought to identify safety lapses that, if prevented, could reduce the need for unnecessary HD after AKI; Methods: We conducted a retrospective observational study that included consecutive patients treated with HD for AKI at a large, tertiary academic center between 1 September 2015 and 31 August 2016. Exposures of interest were pre-specified iatrogenic processes that could contribute to the need for HD after AKI, such as nephrotoxic medication or potassium supplement administration...
October 1, 2018: Journal of Clinical Medicine
Kumar Digvijay, Mauro Neri, Weixuan Fan, Zaccaria Ricci, Claudio Ronco
INTRODUCTION: Definition, prevention, and management of acute kidney injury (AKI) and the optimal prescription and delivery of renal replacement therapy (RRT) are currently matters of ongoing discussion. Due to the lack of definitive published literature, a wide gap might exist between routine clinical practice and available recommendations. The aim of this survey was to explore the clinical approach to AKI and RRT in a broad population of nephrologists and intensivists participating in the 36th International course on AKI and Continuous RRT (CRRT), held in Vicenza in June 2018...
September 28, 2018: Blood Purification
Corey Cavanaugh, Mark A Perazella
Automated urine technology and centralized laboratory testing are becoming the standard for providing urinalysis data to clinicians, including nephrologists. This trend has had the unintended consequence of making examination of urine sediment by nephrologists a relatively rare event. In addition, the nephrology community appears to have lost interest in and forgotten the utility of provider-performed urine microscopy. However, it is critical to remember that urine sediment examination remains a time-honored test that provides a wealth of information about the patient's underlying kidney disease...
September 21, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Cristina Robbiano, Ilenia Infusino, Federica Braga, Alberto Dolci, Mauro Panteghini
BACKGROUND: The morphological examination of urinary sediment (MEUS) is traditionally associated with urinalysis (UA), with workload implications and the need for automation of its execution. METHODS: Considering MEUS as a test requiring specialized knowhow and skill for its execution, since 2005 in our laboratory it is performed for inpatients only upon specific request. Eleven years after, we have analyzed the long-term impact of this approach on the provided service...
September 2018: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Federico Nalesso, Francesco Garzotto, Barbara Rossi, Leda Cattarin, Francesca Simioni, Giovanni Carretta, Giuliano Brunori, Giovanni Gambaro, Lorenzo A Calò
Latent, systemic, organizational and clinical errors may impend on a single clinical reality that is considered safe. These errors may lead to the occurrence of a critical event with possible damage to the patient. The patients' greater clinical complexity, in the field of AKI or CKD, requires a multidisciplinary approach that involves nephrologists and other specialists in the diagnostic-therapeutic-rehabilitative path requiring the administration of personalized extracorporeal blood purification treatments...
July 2018: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Roslyn B Mannon
With the growing wait list of individuals waiting for kidney transplantation, there has been renewed interest in the quality and function of donor organs. In particular, concern about the development of delayed allograft function (DGF) after transplantation continues to lead to the avoidance of donor organs offered to a transplant center. DGF is associated with worse short-and long-term outcomes and associated with higher rejection rates. There are no FDA-approved therapies to mitigate the ischemic injury that occurs...
2018: Nephron
Oleksa G Rewa, Dean T Eurich, R T Noel Gibney, Sean M Bagshaw
BACKGROUND: Continuous renal replacement therapy (CRRT) is a complex and life-sustaining therapy, reserved for our most acutely ill patients, and should be delivered in a safe, consistent and high-quality manner. However valid evidence-based quality indicators (QIs) for CRRT care are lacking. The objective of this study was to develop a prioritized list of QIs for CRRT care that may be used in any CRRT program. METHOD: We conducted a modified three stage Delphi process...
October 2018: Journal of Critical Care
Emma O'Lone, Andrea K Viecelli, Jonathan C Craig, Allison Tong, Benedicte Sautenet, David Roy, William G Herrington, Charles A Herzog, Tazeen Jafar, Meg Jardine, Vera Krane, Adeera Levin, Jolanta Malyszko, Michael V Rocco, Giovanni Strippoli, Marcello Tonelli, Angela Yee Moon Wang, Christoph Wanner, Faiez Zannad, Wolfgang C Winkelmayer, Angela C Webster, David C Wheeler
Patients on long-term hemodialysis are at very high risk for cardiovascular disease but are usually excluded from clinical trials conducted in the general population or in at-risk populations. There are no universally agreed cardiovascular outcomes for trials conducted specifically in the hemodialysis population. In this review, we highlight that trials reporting cardiovascular outcomes in hemodialysis patients are usually of short duration (median 3 to 6 months) and are small (59% of trials have <100 participants)...
June 19, 2018: Journal of the American College of Cardiology
Nithin Karakala, Ashita J Tolwani
Acute kidney injury (AKI) is common in critically ill patients and associated with increased morbidity and mortality. With the increased use of renal replacement therapy (RRT) for severe AKI, the optimal time for initiation of RRT has become one of the most probed and debated topic in the field of nephrology and critical care. There appears to be an increased trend toward earlier initiation of RRT to avoid life-threatening complications associated with AKI. Despite the presence of a plethora of studies in this field, the lack of uniformity in study design, patient population types, definition of early and late initiation, modality of RRT, and results, the optimal time for starting RRT in AKI still remains unknown...
January 1, 2018: Journal of Intensive Care Medicine
M Gupta, B B Feinberg, R M Burwick
Thrombotic microangiopathy (TMA) disorders are characterized by microangiopathic hemolytic anemia, thrombocytopenia and end-organ injury. In pregnancy and postpartum, TMA is most commonly encountered with HELLP (hemolysis, elevated liver enzymes, low platelet count syndrome) or preeclampsia with severe features, but rarely TMA is due to thrombotic thrombocytopenic purpura (TTP) or atypical hemolytic uremic syndrome (aHUS). Due to overlapping clinical and laboratory features, TTP and aHUS are often mistaken for preeclampsia or HELLP...
April 2018: Pregnancy Hypertension
Shirley Chambers, Helen Healy, Wendy E Hoy, Adrian Kark, Sharad Ratanjee, Geoffrey Mitchell, Carol Douglas, Patsy Yates, Ann Bonner
BACKGROUND: Chronic kidney disease (CKD) is a growing global problem affecting around 10% of many countries' populations. Providing appropriate palliative care services (PCS) to those with advanced kidney disease is becoming paramount. Palliative/supportive care alongside usual CKD clinical treatment is gaining acceptance in nephrology services although the collaboration with and use of PCS is not consistent. METHODS: The goal of this study was to track and quantify the health service utilisation of people with CKD stages 3-5 over the last 12 months of life...
April 5, 2018: BMC Palliative Care
Claudio Ronco
Continuous arteriovenous hemofiltration (CAVH) was proposed in 1977 as an alternative treatment for acute renal failure in patients in whom peritoneal dialysis or hemodialysis was clinically or technically precluded. In the mid-1980s, this technique was extended to infants and children. CAVH presented important advantages in the areas of hemodynamic stability, control of circulating volume, and nutritional support. However, there were serious shortcomings such as the need for arterial cannulation and limited solute clearance...
2018: Contributions to Nephrology
Laurel Willig, Erin Paquette, D Micah Hester, Bradley A Warady, John D Lantos
A 3-month-old boy with failure to thrive was referred to a nephrology clinic after a diagnostic workup for failure to thrive revealed a serum urea nitrogen level of 95 mg/dL and creatinine level of 3.6 mg/dL. A renal ultrasound revealed marked bilateral hydronephrosis with little remaining renal cortex in either kidney. A voiding cystourethrogram revealed evidence of posterior urethral valves. The child had no evident comorbidities. Fulguration of the valves was successfully performed but did not lead to improvement in kidney function...
March 2018: Pediatrics
David Y Gaitonde, David L Cook, Ian M Rivera
Chronic kidney disease affects 47 million people in the United States and is associated with significant health care costs, morbidity, and mortality. Because this disease can silently progress to advanced stages, early detection is critical for initiating timely interventions. Multiple guidelines recommend at least annual screening with serum creatinine, urine albumin/creatinine ratio, and urinalysis for patients with risk factors, particularly diabetes mellitus, hypertension, and a history of cardiovascular disease...
December 15, 2017: American Family Physician
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