Nephrology

PURPOSE OF REVIEW: Atrial fibrillation is common among patients with end-stage renal disease undergoing hemodialysis. Although oral anticoagulation is recommended for stroke prevention in most patients with atrial fibrillation, limited evidence is available to guide treatment in hemodialysis patients with this arrhythmia. We summarize the available evidence on the epidemiology of atrial fibrillation in dialysis patients and review the data on the effectiveness of oral anticoagulation in this population...

End-stage renal disease is associated with considerable cardiovascular morbidity and mortality. Atrial fibrillation (AF) is prevalent among dialysis patients and adversely affects the clinical outcome. Vazquez et al. report an increased prevalence and incidence of AF in patients who commence dialysis, and an independent association between arrhythmia and mortality risk. Moreover, they examined clinical and laboratory parameters associated with AF. This population study may fuel research aiming at the development of novel preventive and treatment strategies...

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Atrial fibrillation (AF) is a common cardiac arrhythmia and is associated with an increased risk for thromboembolic stroke. Anticoagulant therapy has been shown to reduce the risk for ischemic stroke in patients with AF; however, these studies have excluded patients with end-stage renal disease (ESRD). This review examines the relationships between ESRD, AF, and the use of anticoagulants to prevent ischemic stroke. Medline and Embase were used to identify relevant articles. Identified review articles and their references were searched...

BACKGROUND: End-stage renal disease (ESRD) patients are more at risk for atrial fibrillation (AF) than the general population. However, the prognosis in ESRD patients with paroxysmal AF (PaAF), permanent AF (PAF) and paroxysmal AF transformed to permanent AF (TAF) is unknown. METHODS: In this retrospective longitudinal study, all ESRD patients with PaAF, PAF and TAF between January 2001 and December 2007 were reviewed. The development of thromboembolic events (TEE) was analyzed using Kaplan-Meier analysis and Cox regression...

BACKGROUND: Sudden death is common in end-stage renal disease (ESRD). Cardiac arrhythmia is observed frequently in patients with ESRD and is thought to be responsible for this high rate of sudden death. This study investigated the prevalence and the predictors of arrhythmia in patients on maintenance dialysis. METHODS: Ninety-four patients on hemodialysis program were enrolled in the study. Routine laboratory results were noted. Arrhythmia, periods of silent ischemia, and heart-rate variability analyses were obtained from 24-hour Holter monitor recordings...

BACKGROUND: Atrial fibrillation (AF) frequently occurs in patients with chronic kidney disease (CKD). However, the long-term impact of development of AF on the risk of adverse renal outcomes in patients with CKD is unknown. In this study, we determined the association between incident AF and risk of end-stage renal disease (ESRD) among adults with CKD. METHODS AND RESULTS: We studied adults with CKD (defined as estimated glomerular filtration rate eGFR <60 mL/min per 1...

End-stage renal disease (ESRD) is associated with increased cardiovascular morbidity and mortality. Recent studies indicate that atrial fibrillation (AF) is prevalent among ESRD patients while it adversely affects the clinical outcome. Despite these considerations, AF management in this population is problematic. Notably, most ESRD patients with AF are deprived of the benefits of anticoagulation therapy because of the fear of hemorrhagic complications. This article provides a concise and critical overview of the complex pathophysiology, epidemiology, and discusses the clinical issues regarding the emerging association between ESRD and AF...

Accumulating evidence suggests that atrial fibrillation is highly prevalent among patients with end-stage renal disease. Physicians should be aware of this important association and implement meticulous monitoring of these patients, because the diagnosis of the arrhythmia is often challenging. In this comprehensive review we provide a concise overview of the current literature regarding the epidemiology of atrial fibrillation in end-stage renal disease, as well as the role of associated factors and predictors...

BACKGROUND: Glucocorticoids are widely prescribed for a variety of diseases and are known to cause neuropsychiatric as well as somatic side effects. OBJECTIVE: This article will review the incidence, clinical characteristics, course, and treatment of neuropsychiatric effects of glucocorticoids. METHODS: We performed a literature review of the neuropsychiatric complications of glucocorticoids using the PubMed database. RESULTS: The neuropsychiatric effects of glucocorticoids involve affective, behavioral, and cognitive manifestations...

Corticosteroids (steroids) are associated with numerous adverse drug reactions (ADRs). Long-term ADRs are well characterized, but there are limited data on the incidence and likelihood of short-term ADRs. We sought to determine the incidence of ADRs potentially related to early administration of steroids in kidney and kidney-pancreas transplant recipients and to determine the probability that the ADR was due to the steroid. We retrospectively evaluated the records of all eligible kidney or pancreas-kidney transplants during 2003...

BACKGROUND: Urine microscopy with examination of the urine sediment examination provides useful diagnostic information about the histology of the kidneys. While most nephrologists use urine microscopy to assess for the presence of glomerular diseases, they are less apt to use this diagnostic test when pre-renal acute kidney injury (AKI) or acute tubular necrosis (ATN) is clinically suspected. More often, tests such as fractional excretion of sodium (FeNa) and fractional excretion of urea (FeUrea) are used to differentiate these two causes of acute kidney injury...

Acute tubular necrosis (ATN) is a form of acute renal failure (ARF) that is common in hospitalized patients. In critical care units, it accounts for about 76% of cases of ARF. Despite the introduction of hemodialysis > 30 years ago, the mortality rates from ATN in hospitalized and ICU patients are about 37.1% and 78.6%, respectively. The purpose of this review is to discuss briefly the cause, diagnosis, and epidemiology of ARF, and to review in depth the clinical trials performed to date that have examined the influence of growth factors, hormones, antioxidants, diuretics, and dialysis...

Acute tubular necrosis (ATN) is a syndrome of intrinsic renal failure secondary to ischemic or toxic insults. The histopathologic findings of ATN are inconstant. When present, they are limited to the tubulo-interstitium and often subtle despite profound dysfunction. Experimental models of ATN in healthy animals commonly use single insults that result in extensive injury, circumstances that do not parallel the human situation. Recently, there has been a shift to more clinically relevant models using an acute insult superimposed on predisposing factors...

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No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

Contrast-induced acute kidney injury (CI-AKI) is the most common iatrogenic cause of acute kidney injury after intravenous contrast media administration. In general, the incidence of CI-AKI is low in patients with normal renal function. However, the rate is remarkably elevated in patients with preexisting chronic kidney disease, diabetes mellitus, old age, high volume of contrast agent, congestive heart failure, hypotension, anemia, use of nephrotoxic drug, and volume depletion. Consequently, CI-AKI particularly in high risk patients contributes to extended hospitalizations and increases long-term morbidity and mortality...