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Inoguchi T, Hamada R, Kubota W, Terano C, Harada R, Honda M, Yamaoka S, Yokokawa Y, Yuza Y, Hataya H. Successful High-dose Chemotherapy in Combination With Autologous Peripheral Blood Stem Cell Transplantation in an Anuric Child With Neuroblastoma. J Pediatr Hematol Oncol 2021; 43:e1156-e1158. [PMID: 33625080 DOI: 10.1097/mph.0000000000002090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/23/2020] [Indexed: 11/27/2022]
Abstract
No reports describe high-dose chemotherapy (HDCT) with autologous peripheral blood stem cell transplantation (auto-PBSCT) in pediatric patients with neuroblastoma and end-stage renal disease. Here, we report the case of a patient with high-risk neuroblastoma who developed anuria during treatment. HDCT with auto-PBSCT under hemodialysis, with strict attention to the ultrafiltration volume and dose modification of alkylating agents, was performed. Although the first auto-PBSCT led to engraftment failure, the second auto-PBSCT resulted in successful myeloid engraftment 8 months after anuria. This case demonstrated that HDCT with auto-PBSCT can be safely performed in children with renal failure under hemodialysis.
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Affiliation(s)
| | | | | | | | | | | | - Shoko Yamaoka
- Hematology and Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yuichi Yokokawa
- Hematology and Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yuki Yuza
- Hematology and Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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Abstract
A case of acute kidney injury due to reflex anuria that was caused by retrograde pyelography and required temporary hemodialysis is reported. An 83-year-old Japanese woman presented with anuria 2 days after undergoing bilateral retrograde pyelography for the investigation of gross hematuria. Retrograde pyelography showed no apparent abnormality, such as malignancy or urolithiasis, but pyelorenal extravasation of contrast medium was remarkable. Her anuria improved promptly after hemodialysis, allowing her treatment to conclude with only one hemodialysis session, and a normal renal function was restored with no sequelae. The details of this case and a review of the relevant literature are presented.
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Affiliation(s)
- Makoto Kanno
- Department of Nephrology and Hypertension, Fukushima Medical University, Japan
| | - Kenichi Tanaka
- Department of Nephrology and Hypertension, Fukushima Medical University, Japan
| | | | - Hiroyuki Terawaki
- Department of Nephrology, Teikyo University Chiba Medical Center, Japan
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Yerneni H, Sedlacek M. Reverse corticomedullary differentiation in acute cortical necrosis. Kidney Int 2019; 96:1041. [PMID: 31543142 DOI: 10.1016/j.kint.2019.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/22/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Himabindu Yerneni
- Division of Nephrology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Martin Sedlacek
- Division of Nephrology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.
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Wang Q, Sun M, Ma C, Lv H, Lu P, Wang Q, Liu G, Hu Z, Gao Y. Emphysematous pyelonephritis and cystitis in a patient with uremia and anuria: A case report and literature review. Medicine (Baltimore) 2018; 97:e11272. [PMID: 30407278 PMCID: PMC6250534 DOI: 10.1097/md.0000000000011272] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Emphysematous pyelonephritis (EPN) or cystitis (EC) is a severe infection of the urinary tract with high mortality. EPN is uncommon among the patients of end stage of renal failure (ESRD) CASE PRESENTATION:: A 38-year-old male with uremia and anuria who was on hemodialysis was found to have gas formation in the bilateral pelvis, ureters, and urinary bladder by CT scan. The diagnosis was emphysematous pyelonephritis and cystitis. And Foley catheter was placed and bladder irrigation was performed. Escherichia coli infection was identified in urine culture and antibiotic was prescribed accordingly. Gas disappeared completely and the patient recovered uneventfully. CONCLUSION This is the first case report of asymptomatic EPN and EC in uremic patient, and conservative management was optimistic in this condition. More attention should be paid to EPN and EC happening to ESRD patients.
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Affiliation(s)
- Qiang Wang
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
| | - Meifeng Sun
- Department of Rehabilitation, Affiliated Hospital of Qingdao University, PR China
| | - Chengjun Ma
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
| | - Hailin Lv
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
| | - Peng Lu
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
| | - Qi Wang
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
| | - Guangyi Liu
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
| | - Zhao Hu
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
| | - Yanxia Gao
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
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Peng YH, Yu XM, Yan C, Luo L, Li TS, Xiao J. Recovery of renal function in a heart transplantation recipient with over 300 days of iatrogenic anuria: A case report. Medicine (Baltimore) 2018; 97:e0451. [PMID: 29702997 PMCID: PMC5944477 DOI: 10.1097/md.0000000000010451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/24/2018] [Accepted: 03/26/2018] [Indexed: 01/29/2023] Open
Abstract
RATIONALE Anuria is a severe symptom indicating severe kidney damage. Patient recovery from prolonged anuria is rarely reported. PATIENT CONCERNS A 15-year-old boy received gender- and weight-mismatch heart transplantation (HT) due to dilated cardiomyopathy. He developed severe hypotension, and heart failure 24 hours after surgery, which were relieved by preload reduction treatments. Although, routine examinations did not show any abnormalities in renal function before surgery, anuria occurred 4 days after preload reduction treatments (24-hour urine volume was 23 mL). DIAGNOSIS The patient was diagnosed with acute kidney injury (AKI). INTERVENTIONS He was admitted to continuous renal replacement therapy (CRRT) or hemodialysis. OUTCOMES Surprisingly, his urine volume was gradually, and miraculously, restored to more than 1000 mL/24 hours after over 300 days of anuria. Hemodialysis was not needed in the twentieth month after surgery. Moreover, he partially, recovered renal function. LESSONS This case indicates the likelihood of recovery from long-term anuria.
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Affiliation(s)
- Yong-Hua Peng
- Department of Nephrology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou
| | - Xiao-Min Yu
- Department of Nephrology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou
| | - Chen Yan
- Department of Stem Cell Biology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Rheumatology, The Second Affiliated Hospital of Nanchang University, Nanchang
| | - Lan Luo
- Department of Stem Cell Biology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical Technology Institute of Xuzhou Medical University, Xuzhou, P.R. China
| | - Tao-Sheng Li
- Department of Stem Cell Biology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Jie Xiao
- Department of Nephrology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou
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Stosovic M, Stanojevic M, Radovic M, Naumovic R, Jovanovic D, Simic S, Marinkovic J, Stankovic S, Djukanovic LJ. Comparative Survival Analysis of Urea Kinetic Based Indices. Int J Artif Organs 2018; 28:566-75. [PMID: 16015566 DOI: 10.1177/039139880502800605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Although urea kinetic modeling indices for measuring dialysis dose are recommended by world expert groups, it is not quite clear whether some of these are superior in predicting the outcome over others. This prospective, single-center study was carried out with the aim to compare predictive value of different indices and methods of measuring dialysis dose. Methods The analysis included 93 anuric patients having been on hemodialysis for at least 2 years who were followed-up for 75-months. The dialysis dose was measured by Kt/V (formal UKM, 3 and 2 urea samples), Kt/V (Daugirdas), Kt/V (Lowrie), eKt/V (Daugirdas), URR and TAC urea. Results Correlations between dialysis indices and survival time were significant for all indices (p<0.01) except for TAC. All indices, except for TAC urea, were significant predictors of mortality (multivariate Cox regression analysis; p<0.01) and differences of significant levels among these colinear parameters were small. Conclusion All examined indices except for TAC urea were highly predictive of patient mortality. Daugirdas and Lowrie simplified Kt/V indices are as predictive of all-cause mortality as more complex formal UKM methods in long-term patients on a 3×4h/week schedule.
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Affiliation(s)
- M Stosovic
- Department of Nephrology, University Clinical Center, Belgrade, Serbia and Montenegro.
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D'Souza AVL, Raveendran N, Tanwar RS, Kimmatkar P, Beniwal P, Agarwal D, Vinay V. Acute Stylet Peritoneal Dialysis in Acute Kidney Injury: The Soul Never Dies. J Assoc Physicians India 2017; 65:28-31. [PMID: 28792165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Acute Kidney Injury (AKI) has a significant mortality rate. In developing countries, mortality due to AKI is high due to lack of access to dialysis facilities and related cost. The main goal of International Society of Nephrology (ISN) 0 by 25 initiative is to eliminate deaths due to AKI. Peritoneal dialysis is an underutilized modality in such a scenario. The aim of this study was to look into effectiveness of starting Acute stylet Peritoneal Dialysis (PD) in a resource constraint settings. METHODS In this prospective study conducted over a year, patients with AKI due to various aetiologies were subjected to Acute stylet PD. The clinical Outcome, demographic, biochemical and treatment data was assessed. Descriptive statistics was used to analyze the data. RESULTS A total of 79 (41 anuric, 33 oliguric and 5 nonoliguric) patients were included in the study. Sepsis was the predominant cause of AKI. Recovery was seen in 34% of patients. Patients with relatively preserved urine output recovered with PD in comparison to the anuric patients (p value <0.01). 58% of patients, majority of whom were anuric needed Hemodialysis (HD) in due course (7 ± 3 days) of time. The mortality in our study was 7.5%. CONCLUSIONS Acute stylet PD can be considered as a modality of Renal Replacement Therapy (RRT) to treat a selected (oliguric, nonoliguric) group of AKI patients and as a bridge therapy for HD in those AKI patients in anuria.
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Affiliation(s)
| | | | | | | | | | | | - Vinay Vinay
- Professor and Head, Department of Nephrology, SMS Medical College, Jaipur, Rajashtan
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8
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Summa KC, Jain B. Acute Anuric Renal Failure in an 80-Year-Old Man. JAMA 2017; 317:1471-1472. [PMID: 28399230 DOI: 10.1001/jama.2017.0704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Keith C Summa
- Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Bijal Jain
- Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois2Department of Medicine, Jesse Brown VA Medical Center, Chicago, Illinois
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Jung HY, Lee JH, Park YJ, Kim SU, Lee KH, Choi JY, Park SH, Kim CD, Kim YL, Cho JH. Duration of anuria predicts recovery of renal function after acute kidney injury requiring continuous renal replacement therapy. Korean J Intern Med 2016; 31:930-7. [PMID: 26867084 PMCID: PMC5016271 DOI: 10.3904/kjim.2014.290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 06/30/2015] [Accepted: 07/04/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Little is known regarding the incidence rate of and factors associated with developing chronic kidney disease after continuous renal replacement therapy (CRRT) in acute kidney injury (AKI) patients. We investigated renal outcomes and the factors associated with incomplete renal recovery in AKI patients who received CRRT. METHODS Between January 2011 and November 2013, 408 patients received CRRT in our intensive care unit. Of them, patients who had normal renal function before AKI and were discharged without maintenance renal replacement therapy (RRT) were included in this study. We examined the incidence of incomplete renal recovery with an estimated glomerular filtration rate < 60 mL/min/1.73 m(2) and factors that increased the risk of incomplete renal recovery after AKI. RESULTS In total, 56 AKI patients were discharged without further RRT and were followed for a mean of 8 months. Incomplete recovery of renal function was observed in 20 of the patients (35.7%). Multivariate analysis revealed old age and long duration of anuria as independent risk factors for incomplete renal recovery (odds ratio [OR], 1.231; 95% confidence interval [CI], 1.041 to 1.457; p = 0.015 and OR, 1.064; 95% CI, 1.001 to 1.131; p = 0.047, respectively). In a receiver operating characteristic curve analysis, a cut-off anuria duration of 24 hours could predict incomplete renal recovery after AKI with a sensitivity of 85.0% and a specificity of 66.7%. CONCLUSIONS The renal outcome of severe AKI requiring CRRT was poor even in patients without further RRT. Long-term monitoring of renal function is needed, especially in severe AKI patients who are old and have a long duration of anuria.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jang-Hee Cho
- Correspondence to Jang-Hee Cho, M.D. Division of Nephrology, Department of Internal Medicine, Kyungpook National University School of Medicine, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Korea Tel: +82-53-420-6314 Fax: +82-53-423-7583 E-mail:
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Xiong L, Fan L, Xu Q, Zhou Q, Li H, Peng X, Yang Y, Wang Y, Yu X, Mao H. Faster Transport Status and Mortality in Anuric Patients Undergoing Continuous Ambulatory Peritoneal Dialysis. Blood Purif 2015; 40:160-6. [PMID: 26278549 DOI: 10.1159/000433416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/18/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND There are limited data regarding the relationship between transport status and mortality in anuric continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS According to the dialysate to plasma creatinine ratio (D/P Cr), 292 anuric CAPD patients were stratified to faster (D/P Cr ≥0.65) and slower transport groups (D/P Cr <0.65). The Cox proportional hazards models were used to evaluate the association of transport status with mortality. RESULTS During a median follow-up of 22.1 months, 24% patients died, 61.4% of them due to cardiovascular disease (CVD). Anuric patients with faster transport were associated with an increased risk of all-cause mortality (HR (95% CI) = 2.16 (1.09-4.26)), but not cardiovascular mortality, after adjustment for confounders. Faster transporters with pre-existing CVD had a greater risk for death compared to those without any history of CVD. CONCLUSION Faster transporters were independently associated with high all-cause mortality in anuric CAPD patients. This association was strengthened in patients with pre-existing CVD.
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11
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Kuttnig M, Zobel G, Ring E, Trop M. Parenteral nutrition during continuous arteriovenous hemofiltration in critically ill anuric children. Contrib Nephrol 2015; 93:250-3. [PMID: 1802591 DOI: 10.1159/000420230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- M Kuttnig
- Department of Pediatrics, University of Graz, Austria
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12
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NAKAMOTO S, KOLFF J. Treatment of Anuria and Uremia Following Transfusions Accidents. International Society of Blood Transfusion 2015; 13:479. [PMID: 14478121 DOI: 10.1159/000426477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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13
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Kutlucan A, Demir M, Turker Y, Sezer MT, Kutlucan L, Tunc N, Altuntas A, Ugan Y. Does the inhibition of renin-angiotensin system decrease inter-dialytic weight gain in anuric hemodialysis patients? Eur Rev Med Pharmacol Sci 2015; 19:70-76. [PMID: 25635977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Knowledge about the inhibition of centrally located angiotensin-I (AT-I) receptors by highly lipophilic AT-I receptor blockers and its' effect are limited with experimental studies. Thus, we aimed to investigate the effect of Telmisartan on Inter-dialytic weight gain (IDWG) % and echocardiographic measurements in anuric hemodialysis (HD) patients. PATIENTS AND METHODS A total of forty-one anuric HD patients with ≥ 6 months maintenance on HD were included in this prospective, randomized and self-controlled study. Four weeks prior the study, angiotensin converting enzyme blockers and AT-I receptor blocker drugs were stopped. Patients were assessed three times during the study protocol. These are baseline, three months later (without Telmisartan period) and three months after Telmisartan therapy. RESULTS IDWG % was significantly decreased in the period of with Telmisartan compared to period without Telmisartan (5.6 ± 1.0% vs 5.3 ± 1.0%, p = 0.03). After the administration of Telmisartan left ventricule end-diastolic diameter (LVEDD) (p = 0.001) and inferior vena cava diameter (IVCD) (19.1 ± 3.8 mm vs 17.3 ± 4.2 mm, p = 0.001) were significantly decreased compared to the period of without Telmisartan. Despite of significantly changes observed in IVCD and LVEDD measurements in a period without Telmisartan, there was no significantly difference in left ventricular mass index (LVMI) measurements in this period. However, LVMI was significantly regressed after the administration of Telmisartan (269.3 ± 82.7 g vs 256.3 ± 70.3 g, p = 0.003 respectively). CONCLUSIONS Treatment of anuric HD patients with Telmisartan at a dose of 40 mg a day reduces IDWG%, LVEDD and IVCD measurements. Further studies investigating the long-term effect of these beneficial effects on clinical outcomes are necessary.
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Affiliation(s)
- A Kutlucan
- Department of Internal Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey.
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14
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Savić S, Vukotić V, Lazić M, Savić N. Management of calculus anuria using ureteroscopic lithotripsy as a first line treatment: its efficacy and safety. Urol J 2014; 11:1392-1399. [PMID: 24807749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 12/12/2013] [Indexed: 06/03/2023]
Abstract
PURPOSE To present our experience with emergency ureteroscopic lithotripsy (URSL) for ureteral calculi associated with acute kidney injury (AKI). MATERIALS AND METHODS We retrospectively evaluated the 61 patients consisted of 90 ureteral units (UU), who underwent URSL. The cause of anuria was bilateral calculus obstructions in 29 cases, and unilateral calculus obstruction with, absent, nephrectomized contralateral kidney in 32 cases. In the case of bilateral synchronous ureteric calculi same-session bilateral ureteroscopy (SBBU) was done. The duration of anuria varied between 12 to 72 hours. At the end of the procedure, ureteral stent was systematically left in place in all patients. Surgery was performed 6-12 hours after admission to hospital. Patients were followed at least 1 month postoperatively. RESULTS The stone free rates (SFR) were determined as baseline, on the first post-operative day, and as overall on the 30 days after procedure. The greatest success was achieved in the distal localization of stones up to 10 mm (93%). Renal function returned in 51 (83.6%) patients within 7 days. In 18 (29.5%) patients [18 (20%) UU] we performed second procedure as extracorporeal shockwave lithotripsy in 16.7% and open surgery in 2.2%. In 43 (70.5%) patients URSL was a successful therapeutic approach in dealing with pain, obstruction and calculus. CONCLUSION Calculus anuria is a medical emergency that requires rapid diagnosis and prompt treatment for the purpose of decompression. URSL is the proper method of choice for selected patients and can be performed safely and has high success rates with minimal morbidity.
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Affiliation(s)
- Slaviša Savić
- Department of Urology, Dr D. Mišovic Clinical Center, Belgrade, Serbia.
| | - Vinka Vukotić
- Department of Urology, Dr D. Mišovic Clinical Center, Belgrade, Serbia
| | - Miodrag Lazić
- Department of Urology, Dr D. Mišovic Clinical Center, Belgrade, Serbia
| | - Nataša Savić
- Department of Urology, Dr D. Mišovic Clinical Center, Belgrade, Serbia
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Sakao Y, Sugiura T, Tsuji T, Ohashi N, Yasuda H, Fujigaki Y, Kato A. Clinical manifestation of hypercalcemia caused by adrenal insufficiency in hemodialysis patients: a case-series study. Intern Med 2014; 53:1485-90. [PMID: 25030558 DOI: 10.2169/internalmedicine.53.1104] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The goal of this study was to clarify the clinical manifestation of hypercalcemia due to hypoadrenalism in hemodialysis (HD) patients. METHODS We retrospectively analyzed the clinical characteristics of five HD patients who had presented with hypercalcemia due to adrenal insufficiency (age: 69 ± 7 [58-75] years old, time on HD: 13 ± 11 [2-32] years). We conducted corticotropin-releasing hormone (CRH) and adrenocorticotropic hormone (ACTH) stimulation tests. We also examined serum bone turnover markers before and after glucocorticoid replacement. RESULTS All patients had critical illnesses at the onset of hypercalcemia. They had at least one symptom, such as eosinophilia, hypoglycemia, or fever. The prevalence of hypercalcemia due to adrenal insufficiency was 1.3% in maintenance HD patients on admission. The causes of adrenal insufficiency were isolated ACTH deficiency, pituitary apoplexy, pituitary atrophy, glucocorticoid withdrawal syndrome, and unilateral adrenalectomy. Serum calcium (Ca) levels corrected by serum albumin were maximally increased to 12.9 to 14.3 mg/dL in four anuric HD patients and mildly elevated to 10.4 mg/dL in a patient with residual diuresis. Their basal serum cortisol levels ranged from <1.0 to 15.4 μg/dL. Single CRH injections failed to increase serum cortisol in any of the patients. Glucocorticoid replacement acutely normalized serum Ca and decreased levels of carboxy-terminal telopeptide of type I collagen, a marker of bone resorption. CONCLUSION Adrenal insufficiency could therefore be an occult cause of hypercalcemia in anuric HD patients who are critically ill.
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Affiliation(s)
- Yukitoshi Sakao
- Blood Purification Unit, Hamamatsu University School of Medicine, Japan
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16
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Iborra-Moltó C, López-Roig S, Pastor-Mira MDLÁ. Prevalence of adherence to fluid restriction in kidney patients in haemodialysis: objective indicator and perceived compliance. Nefrologia 2012; 32:477-485. [PMID: 22806282 DOI: 10.3265/nefrologia.pre2012.feb.11236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2012] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Studies of adherence to fluid restriction show high variability in prevalence data, as different methods of measuring IWG (interdialysis weight gain) and cut-off criteria are used. OBJECTIVES To describe the prevalence of adherence to fluid restriction using daily IWG (criterion: ≤1 Kg) and daily IWG adjusted for dry weight (DW) (cut-off point adjusted criterion: DW<70 kg, IWG=1 kg/day; DW>70 kg and ≤80 kg, IWG=1.1 kg/day; DW>80 kg and ≤90 kg, IWG=1.2 kg/day; DW>90 kg, IWG=1.3 kg/day) and to study the association between this objective indicator and adherence behaviour as reported by patient. PATIENTS AND METHOD Our study included a total of 146 patients with a mean age of 66 years (SD: 13.6 years; range: 25-88 years), 66% of which were male. Ours was a longitudinal study with one month of follow-up. We collected both sociodemographic and clinical variables and mean daily IWG. Patient-reported adherence behaviour was assessed through an interview by a trained staff member from outside the department who asked the following question: "In order to avoid complications between haemodialysis sessions: during the last month, how many days did you ingest less than 1 litre of fluid per day?" (0= no days; 10= every day). A score ≤5 led to categorisation of patients as compliant with treatment. Statistical analysis included descriptive analysis, correlation test, chi-square and Crosstabs, ROC curve and logistic regression procedures. RESULTS Prevalence of "objective" adherence to fluid restriction was 61% (mean daily IWG≤1kg) and 73% (mean daily IWG adjusted for dry weight). Reported adherence (prevalence: 56.2%) was associated with IWG adjusted for weight (chi-square =31.34; P=.000). In patients with objective adherence adjusted for weight, the prevalence of reported adherence was 1.65 times that of non-adherence (PR=1.65; 95% CI: 1.29-2.11). The final model for estimating the association between reported adherence behaviour and daily adjusted IWG included: age (higher), dry weight (lower), potassium (lower), time on haemodialysis treatment (less) and its interaction with reported behaviour (F=50.70; P=.000; R2=44%). The sensitivity of reported adherence behaviour for detecting objective adherence adjusted for dry weight was 89%; specificity was 58%, and the overall classification power was 85% (AUC=.85; 95% CI: 0.78-0.92). The probability of objective adherence adjusted for weight in patients who claimed proper adherence was 9 times higher than in non-compliant patients in patients who had been on HD for 2.3 years (PORp25=9.16; 95% CI: 2.58-32.51); 6 times higher in patients on HD for 4.7 years (PORP50=6.16; 95% CI: 2.1217.92); and 3 times higher in those on HD for 8.2 years (PORp75=3.44; 95% CI: 1.32-8.96). CONCLUSIONS Prevalence of adherence to fluid restriction was 73% and 16% depending on daily IWG adjusted/not adjusted for dry weight, respectively. Absolute daily IWG adjusted for weight seems a good indicator of adherence, as it allows for a personalised fluid restriction regimen. Significant association between this objective indicator and reported adherence behaviour supports a combination of patient approach and objective data, which can help with the adjustment of the individual cut-off for daily IWG. This also provides useful information for designing intervention strategies to maintain and increase adherence.
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Affiliation(s)
- Carmelo Iborra-Moltó
- Unidad de Hemodiálisis, Clínica Vistahermosa, Avda. Dénia, 103, 03015 Alicante, Spain.
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Eden G, Busch M, Kühn-Velten WN, Schneider A, Kielstein JT. Successful treatment of life-threatening pentoxifylline intoxication by high-flux hemodialysis. Clin Nephrol 2011; 75:171-173. [PMID: 21255548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
High-flux hemodialysis is the method of choice for the treatment of many life threatening intoxications. Reports on intoxication with pentoxifylline are rare, and although pharmacokinetic properties of the drug suggest a potential role for hemodialysis, there are no published reports on extracorporeal treatment attempts. We report the first case of successful treatment of potentially life-threatening pentoxifylline intoxication by high-flux hemodialysis. Based on this single case, dialysis should be considered, especially in anuric patients with pentoxifylline intoxication.
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Affiliation(s)
- G Eden
- Department of Nephrology and Hypertension, Center for Internal Medicine, Medical School Hannover, Hannover, Germany
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18
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Kanter Berga J, Cáceres Borrero C, Ripollés González T, Avila Bernabeu A, Gavela Martínez E, Pallardó Mateu L. [Delayed spontaneous rupture of the kidney graft]. Nefrologia 2010; 30:707-709. [PMID: 21113228 DOI: 10.3265/nefrologia.pre2010.aug.10591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2010] [Indexed: 05/30/2023] Open
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Khan G, Lal S, Soomro MI, Jalbani MH. Calculus anuria and its remedy. J Ayub Med Coll Abbottabad 2010; 22:112-114. [PMID: 21409919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Urinary lithiases have been a major urological problem. The objective was to determine the out come of treatment for patients with calculus anuria. METHODS A descriptive study was conducted at Department of Urology Chandka Medical College Hospital, Larkana from March 2007 to April 2009. All patients with a diagnosis of calculus anuria of all ages and either sex were included in the study. Detailed history, physical examination and examination of genitourinary tract was performed. Investigations included complete blood examination, blood urea, serum creatinine, ultrasonography of KUB area, and X-Ray KUB. RESULTS Among the 66 patients the cause of anuria was bilateral obstruction by the calculi in 46 cases, unilateral obstruction with small/absent/nephrectomised contralateral kidney in 20 cases. In most of the cases, ureteric catheterisation was done to relieve the obstruction. Five deaths were observed, despite emergency urinary diversion and appropriate treatment. CONCLUSION Calculus anuria is a urological emergency. Prompt and early intervention can save the life of patient and prevent to develop chronic renal failure.
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Al-Wakeel JS, Hammad D, Memon NA, Tarif N, Shah I, Chaudhary A. Serum cystatin C: a surrogate marker for the characteristics of peritoneal membrane in dialysis patients. Saudi J Kidney Dis Transpl 2009; 20:227-231. [PMID: 19237809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
To evaluate whether cystatin C levels can be a surrogate marker of creatinine clearance and reflect the characteristics of peritoneal membrane in dialysis patients, we performed peritoneal equilibration tests (PET) in 18 anuric adult chronic peritoneal dialysis (PD) patients with a mean age of 39.7 +/- 20 years. All the samples were analyzed for urea, creatinine, and cystatin C. Peritoneal transport, mass transfer, and peritoneal clearance of cystatin C were calculated. Correlation and regression analysis was done using cystatin C as a dependent variable and age, sex, height, weight, body surface area, and creatinine as independent variables. Cystatin C demonstrated a significant time dependent increase of dialysate concentration and decline in the serum concentrations during PET, and a strong correlation between serum creatinine and serum cystatin C concentrations(r: 0.62, p= 0.008). The trans-peritoneal clearance (mL/min/1.73 m 2 ) of cystatin C was related to its serum concentration and was similar to creatinine in its pattern but of smaller magnitude. Peritoneal mass transfer (mg/4 hr per 1.73 m 2 ) for cystatin C serum creatinine was 1.68 +/- 0.67 and 73.3 +/- 29.8, respectively. The dialysis/plasma D/P cystatin C concentration was > or = 0.1 at 4 hrs of PET denoted high peritoneal transport, while the values of < 0.1 denoted low transport type. We conclude that cystatin C follows the same pattern of peritoneal exchange as creatinine but the magnitude of transfer is many folds lower than creatinine. At present clinical utility of cystatin C in the evaluation of solute clearance is probably limited due to the minute amounts transferred across the membrane and the high renal clearance in the presence of residual renal function.
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Affiliation(s)
- Jamal S Al-Wakeel
- Department of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia.
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21
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Neary B, Colovic V. Perioperative management of a hyperkalemic infant. Paediatr Anaesth 2009; 19:268-9. [PMID: 19236646 DOI: 10.1111/j.1460-9592.2008.02913.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Rodrigues AS. Peritoneal dialysis in anuric patients: old problems and new perspectives. Perit Dial Int 2009; 29 Suppl 2:S233-S235. [PMID: 19270225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Anuric patients are often excluded from peritoneal dialysis (PD) because of the fear that PD is inadequate to treat this higher-risk group of patients. However, advances in PD knowledge and technique allow better and adjusted treatments. There is now clinical evidence that anuric patients can be successfully treated with PD, while new solutions promise to mitigate some limitations of automated PD, such as sodium and fluid removal and preservation of membrane function.
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Gholyaf M, Afzali S, Babolhavaegi H, Rahimi A, Wagharseyedayn SA. Reflex anuria affecting both kidneys following hysterectomy. Saudi J Kidney Dis Transpl 2009; 20:120-123. [PMID: 19112230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
In situations when there is unilateral ureteral obstruction, the contralateral kidney retains its normal function. In rare instances however, it has been reported that unilateral ureteral obstruction can lead to reflex anuria (RA) and acute renal failure (ARF). Even more unusually, RA with ARF can occur without organic obstruction due to ureteric manipulation during pelvic surgery. We report a 78- year-old woman, who underwent hysterectomy because of endometrial carcinoma. She developed ARF evidenced by anuria of 120-hours duration, and gradual rise of serum creatinine levels to 11.8 mg/dL on the fifth day after hysterectomy. Ultrasound study of the urinary tract revealed bilateral moderate hydronephrosis. Detailed evaluation did not reveal any organic obstruction. She was managed with hemodialysis, control of hypertension and correction of fluid and electrolyte imbalances. By the sixth day, diuresis was established, and the blood urea and serum creatinine levels decreased to normal by the sixteenth day. The patient was finally discharged on the eighteenth day. Our case suggests that urologists and nephrologists should consider RA as one of the causes of anuria and ARF.
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Affiliation(s)
- Mahmoud Gholyaf
- Department of Nephrology, Ekbatan Hospital, Hamedan University of Medical Sciences and Health Services, Hamedan, Iran.
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Zambrano O P, Delucchi B A, Cavagnaro S F, Hevia J P, Rosati M MP, Lagos R E, Nazal Ch V, González C C, Barrera B P, Alvarez L E, Pinto S V, Salas del C P, Cano Sch F, Contreras M A, Galanti de la P M, Gana A JC, Zamorano C J, Espinoza B A, Dreves R P, Pereira M J, Bidegain S A, Pasten P E, Yáñez P L, Cerda F V, Rodríguez S E, Aglony I M, Gutiérrez I E, Salas P F, Figueroa Y S, Valenzuela A M, Grandy H J, Guerra A B, Lapadula A M, Reutter de la M P, Gallardo T V, Maldonado S D, Azócar P M, Cavada Ch G. [Hemolytic-uremic syndrome in Chile: clinical features, evolution and prognostic factors]. Rev Med Chil 2008; 136:1240-1246. [PMID: 19194619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Hemolytic-uremic syndrome (HUS) is characterized by acute renal failure, microangiopathic hemolytic anemia and thrombocytopenia. AIM To describe the characteristics of patients with the diagnosis of HUS in Chile, and to identify the most reliable early predictors of morbidity and mortality. MATERIAL AND METHODS The clinical records of patients with HUS aged less than 15 years, attended between January 1990 and December 2003 in 15 hospitals, were reviewed. Demographic, clinical, biochemical, hematological parameters, morbidity and mortality were analyzed. RESULTS A cohort of 587 patients aged 2 to 8 years, 48% males, was analyzed. Ninety two percent had diarrhea. At the moment of diagnosis, anuria was observed in 39% of the patients, hypertension in 45% and seizures in 17%. Forty two percent required renal replacement therapy (RRT) and peritoneal dialysis was used in the majority of cases (78%). The most frequently isolated etiological agent was Escherichia coli. Mortality rate was 2.9% in the acute phase of the disease and there was a positive correlation between mortality and anuria, seizures, white blood cell count (WCC)>20.000/mm3 and requirements of renal replacement therapy (p<0.05). Twelve percent of patients evolved to chronic renal failure and the risk factors during the acute phase were the need for renal replacement therapy, anuria, WCC>20.000/mm3, seizures and hypertension. CONCLUSIONS The present study emphasizes important clinical and epidemiological aspects of HUS in a Chilean pediatric population.
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Affiliation(s)
- Pedro Zambrano O
- Unidad de Nefrología, Hospital de Niños Dr. Exequiel González Cortés, Santiago, Chile.
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25
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La Manna G, Pancaldi L, Dalmastri V, Cuna V, Capecchi A, Comai G, Persici E, Bacchi G, Cianciolo G, Lombardi A, Marrozzini C, Colì L, Stefoni S. Post-coronarography application of continuous veno-venous hemofiltration in the prevention of contrast nephropathy in patients with complex multisystem deficiency. In Vivo 2008; 22:123-129. [PMID: 18396794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND An increased admission of high-risk patients to diagnostic and interventional radiological procedures with contrast medium has resulted in an increase of contrast-induced nephropathy, which now represents the third main cause of hospital-acquired acute renal failure. The pathogenic mechanism of contrast-induced nephropathy (CN) is unclear, but there is much evidence which indicated an interaction between direct tubular cytotoxicity and osmotic/hemodynamic effects. Continuous veno-venous hemofiltration (CVVH) has shown possible benefits in preventing CN. It is not understood when and how prophylactic strategies should be used either in pharmacological therapies or in continous renal replacement therapy (CRRT) approaches. The aim of this study was to evaluate the efficiency of the CVVH technique in preventing CN secondary to emergency radiological procedures in very high-risk patients. PATIENTS AND METHODS Twelve patients with severe chronic renal impairment (serum creatinine concentration >2 mg/dl with an estimated glomerular filtration rate (eGFR) <40 ml/min) in association with at least two severe comorbidities (such as previous acute myocardial infarction in hypertensive or diabetic patients obesity, cardiac failure with ejection fraction <40%, severe hypotension) were treated with CVVH after coronarography using an iso-osmolar contrast medium (Visipaque, Iodixanol), with or without percutaneous transluminal coronary angioplasty. Adverse events and their association with the interventional radiological procedure were investigated after hemofiltration. RESULTS Statistically significant differences were observed for both eGFR and serum creatinine at different time points (pre-, post- and 7 days after the procedure) at p<0.05. Statistical analysis of all the variables related to the radiological procedure and the hemofiltration technique did not cause any modification of renal function between the pre- and post-procedure values. No patient showed signs of cardiovascular instability, nor were any episodes of marked hypotension reported during the dialysis session. No patient showed any adverse effects related to the interventional radiological procedure or to the CVVH technique. Renal function, according to serum creatinine concentration and the e-GFR calculation (Cockcroft), did not worsen but had improved when the patients left hospital, with function rates statistically significantly better compared to that on hospital admission, even 7 days after the radiological procedure. CONCLUSION The present study suggests the efficiency of the CVVH technique in preventing CN in high-risk patients who need to undergo interventional radiological cardiovascular procedures involving the administration of an iodine-based contrast medium.
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Affiliation(s)
- Gaetano La Manna
- Nephrology, Dialysis and Renal Transplant Unit, University of Bologna, St. Orsola University Hospital, Bologna, Italy.
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Bohé J, Juillard L. [Acute renal failure. Anuria]. Rev Prat 2007; 57:1953-1962. [PMID: 18095637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Julien Bohé
- INSERM U. 870/INRA U. 1235/INSA/UCBL/HCL, Réanimation médicale, centre hospitalier Lyon-Sud, 69310 Pierre-Bénite.
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Affiliation(s)
- Daniel J Rosen
- Department of General Surgery, St. Luke's-Roosevelt Hospital Center, New York, New York, USA
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Wahba IM, Bennett WM. Increased vascular resistance and not salt retention characterizes cyclosporine A-induced hypertension: report in an anuric patient. Am J Transplant 2007; 7:2042-6. [PMID: 17578503 DOI: 10.1111/j.1600-6143.2007.01871.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cyclosporine A (CsA) use is associated with hypertension in most solid-organ transplant recipients. The mechanisms of CsA-induced hypertension have not been fully elucidated and are still controversial. We present a case of CsA-induced hypertension who was anuric and receiving hemodialysis, and in whom noninvasive cardiothoracic bioimpedence revealed elevated systemic vascular resistance without evidence of fluid-volume overload. We briefly discuss the possible mechanisms of CsA-induced hypertension in light of this information.
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Affiliation(s)
- I M Wahba
- Department of Medicine, Division of Nephrology and Hypertension, Oregon Health & Science University, Portland, OR, USA.
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30
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de Kemp VF, Beganovic A, Stapper G, Moll FL, Boer WH, Lock MTWT. [Fatigue, loss of appetite and anuria due to retroperitoneal fibrosis]. Ned Tijdschr Geneeskd 2007; 151:1373-4; author reply 1374. [PMID: 17665630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Barakat RK, Schmolck JP, Finkel KW, Foringer JR. Prolonged renal failure secondary to antithymocyte globulin treatment in severe aplastic anemia. Ann Pharmacother 2007; 41:895-8. [PMID: 17426071 DOI: 10.1345/aph.1k036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To report a case of acute renal failure in a patient with severe aplastic anemia after administration of antithymocyte globulin (ATG). CASE SUMMARY A 41-year-old man diagnosed with severe aplastic anemia was treated with ATG and cyclosporine. After one dose of ATG (3012 mg, 40 mg/kg), the patient developed anuric acute renal failure, with serum creatinine 3.4 mg/dL (1.2 mg/dL at baseline) and blood urea nitrogen (BUN) 29 mg/dL (13 mg/dL at baseline), which required intermittent hemodialysis. Renal failure resolved with cessation of the drug, serum creatinine and BUN returned to baseline levels, and the patient no longer required hemodialysis. DISCUSSION ATG is a purified and concentrated gamma globulin, primarily a monomeric immunoglobulin G from hyperimmune serum of horses. It is widely used to treat severe aplastic anemia and to manage acute transplant rejection. This patient had no other confounding factors for the cause of the renal failure. An objective causality assessment using the Naranjo probability scale suggested that ATG was the probable cause of the acute renal failure. Primary glomerular disease was not excluded, as a renal biopsy was not performed. CONCLUSIONS The association between renal injury and administration of ATG remains unclear; therefore, we recommend that renal function be assessed and carefully monitored prior to and after administration of ATG.
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Affiliation(s)
- Ruchdi K Barakat
- Division of Renal Diseases and Hypertension, The University of Texas Medical School at Houston, Houston, TX 77030, USA
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Abstract
We report the first known case of anuric renal failure after same-session bilateral atraumatic flexible ureteroscopy for renal calculi. Although, there is no consensus about stenting patients who undergo same-session bilateral ureteroscopy due to the lack of prospective randomized studies; strong consideration should be given to stenting the ureter at least one side to avoid this complication.
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Affiliation(s)
- Gaurav Bandi
- Department of Urology, Wayne State University, Detroit, Michigan 48201, USA.
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Davies SJ, Brown EA. EAPOS: what have we learned? Perit Dial Int 2007; 27:131-5. [PMID: 17299145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Affiliation(s)
- Simon J Davies
- Department of Nephrology, University Hospital of North Staffordshire, Stoke-on-Trent, UK.
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Bouman CSC, van Kan HJM, Koopmans RP, Korevaar JC, Schultz MJ, Vroom MB. Discrepancies between observed and predicted continuous venovenous hemofiltration removal of antimicrobial agents in critically ill patients and the effects on dosing. Intensive Care Med 2006; 32:2013-9. [PMID: 17043848 DOI: 10.1007/s00134-006-0397-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Accepted: 09/11/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Drug dosing during continuous venovenous hemofiltration (CVVH) is based partly upon the CVVH clearance (Cl(CVVH)) of the drug. Cl(CVVH) is the product of the sieving coefficient (SC) and ultrafiltration rate (Q(uf)). Although it has been suggested that the SC can be replaced by the fraction of a drug not bound to protein (F(up)), the F(up) values as reported in the literature may not reflect the protein binding in critically ill patients with renal failure. We compared the observed Cl(CVVH) (SC x Q(uf)) with the estimated Cl(CVVH) (estimated F(UP) x Q(uf)) and determined the effect on the maintenance dose multiplication factor (MDMF). DESIGN AND SETTING Clinical study in a mixed ICU in a university hospital. PATIENTS 45 oligoanuric patients on CVVH (2 l/h). INTERVENTIONS Timed blood and ultrafiltrate samples. MEASUREMENTS AND RESULTS Amoxicillin, ceftazidime, ciprofloxacin, fluconazole, metronidazole, and vancomycin were easily filtered (mean SC > 0.7) but not flucloxacillin (mean SC 0.3). Predicted and observed Cl(CVVH) corresponded only for fluconazole and metronidazole. The difference between observed and predicted MDMF was small for all drugs, with the exception of ceftazidime (mean 0.25, 95% CI -0.96 to 1.48) and vancomycin (0.05, -1.34 to 1.45). However, this difference was clinically relevant only for vancomycin, because of its narrow therapeutic index. CONCLUSIONS Dosing based on predicted CVVH removal provides an as reliable estimate than that based on observed CVVH removal except for those antibiotics that have both a narrow therapeutic index and a predominantly renal clearance (e.g., vancomycin).
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Affiliation(s)
- Catherine S C Bouman
- Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
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Barrell GK, McFarlane RG, Slow S, Vasudevamurthy MK, McGregor DO. CAPD in sheep following bilateral nephrectomy. Perit Dial Int 2006; 26:598. [PMID: 16973517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Affiliation(s)
- Graham K Barrell
- Agriculture and Life Sciences Division Lincoln University, Canterbury, New Zealand.
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Kuriyama S, Otsuka Y, Iida R, Matsumoto K, Hosoya T. Icodextrin with small and short dwell enhances ultrafiltration in peritoneal dialysis patients with severe overhydration. Perit Dial Int 2006; 26:508-9. [PMID: 16881350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
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Abstract
Calciphylaxis is a disabling and life-threatening complication that primarily affects patients who are dialysis dependent. This disease entity is characterized by calcification, intimal hypertrophy, and thrombosis of small vessels, which results in necrotizing, nonhealing ulcers. The development of these lesions portends a grim prognosis, as they are often accompanied by severe and sometimes fatal infectious complications. Although several strategies aimed at treating and preventing this affliction have been reported in the literature, the outcome for most patients with calciphylaxis remains quite poor. We describe an anuric hemodialysis patient who developed severe calciphylaxis that proved refractory to conventional treatment. Following extensive debridement of several wounds, intravenous sodium thiosulfate was utilized as an adjunctive therapy four times a week. Within 6 months, excellent wound healing ensued as well as a dramatic improvement in the lesions that were not previously resected. Aside from occasional nausea, these treatments were well tolerated, despite the development of an anion gap metabolic acidosis. After 34 months of continued treatment the patient remains free from disease recurrence and has demonstrated no untoward effect of prolonged therapy. In an effort to delineate the pharmacokinetics of this drug in a hemodialysis patient, serum thiosulfate levels were obtained 15 minutes after infusion as well as before and after subsequent dialysis treatments. Consistent with prior studies in anuric canines, we found measurable quantities of the drug more than 50 hours after treatment, in addition to a markedly elevated half life of 478 minutes. However, given the lack of significant toxicity, as well as a dramatic clinical improvement, we feel that sodium thiosulfate may have an important adjunctive role in the treatment of calciphylaxis in dialysis patients.
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Affiliation(s)
- Michael Brucculeri
- Division of Nephrology and Hypertension, New York Presbyterian Hospital, New York, New York 10021, USA.
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Abstract
The article by Ni et al. solidifies the important role of aquaporin-1 in the process of fluid removal from anephric patients treated with peritoneal dialysis. The presence of the water-only channel in the subperitoneal endothelia provides the mechanism for solute-free ultrafiltrate observed early in dialysis and accounts for approximately half of all the filtration observed in dialysis.
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Affiliation(s)
- M Flessner
- University of Mississippi Medical Center, Jackson, Mississippi, USA.
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Geddes CC, Woo YM. The European Best Practice Guidelines (EBPG) for peritoneal dialysis recommendation for minimum Kt/Vurea is not supported by current evidence. Nephrol Dial Transplant 2006; 21:2674. [PMID: 16554321 DOI: 10.1093/ndt/gfl111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lomonte C, Vernaglione L, Cazzato F, Casucci F, Chimienti D, Bruno A, Cocola S, Basile C. Post-parathyroidectomy serum phosphate kinetics is peculiar to female hemodialysis patients with a high body mass index. J Nephrol 2006; 19:70-6. [PMID: 16523429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Persistent hyperphosphatemia is one of the most important factors in the development of secondary hyperparathyroidism (sHPTH). Recently, we demonstrated that a higher body mass index (BMI) and female gender could predispose to a larger phosphate (P) body burden, thereby influencing the severity of sHPTH. METHODS This prospective study aimed to verify if these two risk factors, i.e. BMI and female gender, also influenced calcium (Ca) and P kinetics in the immediate post-parathyroidectomy (PTx) period in 42 consecutive adult Caucasian anuric hemodialysis (HD) patients referred for first PTx. Serum Ca and P were measured pre-PTx and on the 5 consecutive post-PTx days; serum immunoreactive parathyroid hormone (iPTH) and alkaline phosphatase (ALP) levels were measured pre-PTx and 3 days post-PTx. RESULTS Ablation of parathyroid tissue determined a significant reduction in serum iPTH, ALP, Ca and P (p = 0.001). The stratification of the cohort into four groups according to the cut-off value of BMI = 25 kg/m(2) and according to gender showed the following: males and females with BMI >25 kg/m(2) (analyzed both separately and as a subgroup including males and females) had significantly higher pre-PTx serum P levels, when compared with the respective sub-groups with BMI <25 kg/m(2) (p < 0.01); a significantly higher mean area under the concentration curve (AUC) of serum P was observed in the high BMI group (males and females), when compared with the low/normal BMI group (p = 0.03); the serum P kinetics in the 5 post-PTx days did not differ between the two groups of male patients (low/normal BMI males vs. high BMI males), whereas a significantly higher mean serum P AUC was observed in the high BMI female patients, when compared with the low/normal BMI female patients (p = 0.003); finally, the serum P kinetics in the 5 post-PTx days did not differ between the two groups of low/normal male and female patients, whereas a significantly higher mean serum P AUC was observed in the high BMI female patients, when compared with the high BMI male patients (p = 0.006). A linear multiple regression analysis with the serum P AUC of each patient as a dependent variable and BMI, gender, age and dialysis duration as independent variables showed that BMI (p = 0.0001) and female gender (p = 0.001) were independent predictors of the serum P AUC. CONCLUSIONS High BMI and female gender are associated with peculiar serum P kinetics in the immediate post-PTx period, suggesting the existence of a larger P body burden in high BMI female HD patients. The existence of a larger P pool exclusively based on serum P kinetics prompts the need for further studies to better understand such intriguing aspects of bone pathophysiology in response to parathyroid gland removal in chronically uremic patients.
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Affiliation(s)
- Carlo Lomonte
- Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Bari, Italy
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Di Filippo S, Pozzoni P, Manzoni C, Andrulli S, Pontoriero G, Locatelli F. Relationship between urea clearance and ionic dialysance determined using a single-step conductivity profile. Kidney Int 2005; 68:2389-95. [PMID: 16221245 DOI: 10.1111/j.1523-1755.2005.00702.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND On-line determination of ionic dialysance (ID) has been used to measure the clearance of small solutes like urea. However, attempts to determine the in vivo relationship between ID and urea clearance have led to discordant findings. The aim of this study was to determine the relationship between the mean values of repeated instantaneous determinations of ID throughout a dialysis session ((m)ID), obtained using a single-step inlet dialysate conductivity profile, and the mean values of urea clearance corrected for access recirculation (K(eu1)), total recirculation (access plus cardiopulmonary recirculation, K(eu2)), and the entire postdialysis urea rebound (K(wb)). METHODS Eighty-two anuric patients on chronic thrice-weekly hemodialysis were studied using an Integra machine equipped with the Diascan module for the automatic determination of ID. The mean values of repeated ID measurements made at 30-minute intervals were compared with K(eu1) (available for only 31 patients), K(eu2), and K(wb). RESULTS The results in all 82 patients were: (m)ID = 176 +/- 23 mL/min; K(eu2) = 181 +/- 25 mL/min; K(wb) = 159 +/- 22 mL/min. The mean (m)ID/K(wb) and (m)ID/K(eu2) ratios were, respectively, 1.11 +/- 0.06 and 0.98 +/- 0.06. The results in the 31 patients for whom K(eu1) values were available were: (m)ID = 179 +/- 24 mL/min and K(eu1) = 200 +/- 27 mL/min; the mean (m)ID/K(eu1) ratio was 0.90 +/- 0.05. CONCLUSION The mean value of repeated ID determinations obtained using a single-step conductivity profile underestimates urea clearance corrected for access recirculation, and may be considered an adequate estimate of urea clearance corrected for total recirculation.
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Abstract
BACKGROUND Residual glomerular filtration rate (GFR) is a much more important determinant of survival in peritoneal dialysis patients, than peritoneal solute clearances. However, anuric peritoneal dialysis patients are solely dependent on peritoneal solute clearances. The aim of the study was to analyze the effects of peritoneal small solute clearances and ultrafiltration on survival in anuric patients, and to establish the minimum levels of small solute clearances and net ultrafiltration. These objectives were investigated in a prospective cohort study in incident peritoneal dialysis patients who had become anuric during follow-up. METHODS The Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD) is a prospective multicenter cohort study in which new adult dialysis patients are included and followed during 6 months intervals. Included were 542 peritoneal dialysis patients. Of these, 166 developed anuria, 130 of which could be included in the study. RESULTS Two-year patient survival after the outset of anuria was 67%, technique survival 73%, and the combined 2-year patient and technique survival was 50%. Risk factors associated with mortality were age, comorbidity, the duration of peritoneal dialysis before anuria, and a low serum albumin. Peritoneal solute clearances were analyzed time-dependently. These parameters were not associated with survival when analyzed as continuous variables and also not when the analyses were done in quintiles, although the time-dependent approach was almost significant for Kt/V(urea). On the other hand, when the results were analyzed dichotomously using predefined cutoff points, Kt/V(urea) <1.5 per week and creatinine clearance <40 L/week/1.73 m2 were associated with an increase in the relative risk of death. Also peritoneal ultrafiltration was significantly associated with survival. CONCLUSION The survival of anuric peritoneal dialysis patients is in line with expectations based on the duration of dialysis. The risk factors for death are the same as in the dialysis population as a whole. Besides an association with ultrafiltration, our study enabled us to define the lower limits of adequate peritoneal dialysis, that is Kt/V(urea) <1.5 per week and creatinine clearance <40 L/week/1.73 m2.
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Affiliation(s)
- Maarten A M Jansen
- Division of Nephrology, Department of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Lo WK, Lui SL, Chan TM, Li FK, Lam MF, Tse KC, Tang SCW, Choy CBY, Lai KN. Minimal and optimal peritoneal Kt/V targets: results of an anuric peritoneal dialysis patient's survival analysis. Kidney Int 2005; 67:2032-8. [PMID: 15840054 DOI: 10.1111/j.1523-1755.2005.00305.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Residual renal clearance has been shown to be much more predictive of survival than peritoneal clearance. There has been little data to support a target level of peritoneal clearance. A retrospective study was therefore conducted to see how the peritoneal Kt/V had affected the survival of anuric patients in our center. METHODS Over a period of 10 years, there were 150 peritoneal dialysis patients with documented anuria. Their survival was analyzed according to their baseline peritoneal Kt/V at the time of documentation of anuria and at the time of their latest altered peritoneal dialysis (PD) prescription (subsequent Kt/V). RESULTS There were 90 females and 42 diabetics. The mean age and duration of dialysis were 57.7 +/- 14.7 and 44.1 +/- 31.3 months, respectively. The 2-year and 5-year survival rates were 88.7% and 66.7%, respectively. We found that patients with baseline peritoneal Kt/V below 1.67 had poorer survival after the documentation of anuria than those above [relative risk (RR) 1.985, P= 0.01], although the baseline Kt/V was not an independent risk factors in the whole group of patients. However, such effect was mainly observed in female patients. The survival was identical between those with Kt/V above or below 1.80 (P= 0.98). Among female patients, the group with baseline Kt/V 1.67 to 1.86 had the best survival, followed by those greater than 1.86 and lowest in those below 1.67 (P= 0.0016). For patients with baseline Kt/V below 1.80, those with subsequent Kt/V above 1.76 had better survival than those below (P= 0.033). CONCLUSION Our data suggested that a negative effect of peritoneal Kt/V on survival is apparent at a level below 1.67 and there exists a limit of its effect at around 1.80. We suggested a minimal Kt/V target of 1.70 and an optimal target at 1.80 in anuric patients based on survival data. Prospective randomized study is required to confirm this finding.
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Affiliation(s)
- Wai-Kei Lo
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong.
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Takeda H, Ando R, Naito S, Inagaki Y, Hata T, Niwa A, Miyake S, Moroe Y, Katsumi A, Suzaki S, Inoue T. [Bilateral renal cortical necrosis following early elective abortion]. Nihon Naika Gakkai Zasshi 2005; 94:340-2. [PMID: 15768598 DOI: 10.2169/naika.94.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hitoshi Takeda
- Department of Internal Medicine, Musashino Red Cross Hospital, Tokyo
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Moriishi M, Kawanishi H, Watanabe H, Tsuchiya S. Effect of icodextrin-based peritoneal dialysis solution on peritoneal membrane. Adv Perit Dial 2005; 21:21-4. [PMID: 16686279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Using changes in cell counts and levels of cancer antigen 125 (CA125), fibrinogen degradation product (FDP), and interleukin-6 (IL-6) in effluent before and after the use of icodextrin-based peritoneal dialysis solution (icodextrin), we evaluated the effects of icodextrin on peritoneal membrane. The subjects were 8 anuric patients (4 men, 4 women) who had been using a 2.5% glucose-based dialysis solution (glucose solution) for the overnight dwell. The mean age of the patients was 57.9 +/- 6.1 years, and their mean duration of continuous ambulatory peritoneal dialysis was 61.6 +/- 44.3 months. In all patients, chronic glomerulonephritis was the cause of end-stage renal disease. We changed the 2.5% glucose solution used for the 8-hour dwell to an icodextrin, and we compared cell counts in effluent and levels of IL-6, FDP, and CA125 in the overnight effluent before, and 12 and 36 weeks after, the switch to the icodextrin. When 2.5% glucose solution was used for the overnight 8-hour dwell, the mean cell count in the effluent was 5.5 +/- 3 cells/mm3. However, 12 and 36 weeks after the start of icodextrin, mean cell counts in effluent were significantly increased to 15.3 +/- 7.7 cells/mm3 (p < 0.01) and 16.5 +/- 11.2 cells/mm3 (p < 0.01) respectively. Values of effluent CA125, FDP, and IL-6 obtained during the use of a glucose solution were compared to values obtained 12 and 36 weeks after the start of icodextrin. Effluent levels of CA125 and IL-6 did not vary before and after the use of the icodextrin, but levels of FDP in the icodextrin effluent were higher than the levels found in the effluent of a 2.5% glucose solution (7278.8 +/- 2915 ng/mL before the start of icodextrin; 29,875 +/- 13,227 ng/mL 12 weeks after icodextrin introduction, p < 0.01; and 12,062.9 +/- 5684.6 ng/mL 36 weeks after icodextrin introduction). Icodextrin induced a subclinical inflammatory response in the peritoneum. Therefore, biocompatibility of an icodextrin solution is not always superior to that of a glucose solution, and further research is needed to clarify the influence of long-term icodextrin use on the peritoneum.
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Affiliation(s)
- Misaki Moriishi
- Department of Artificial Organs, Akane-Foundation Tsuchiya Hospital, Hiroshima, Japan.
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Abstract
BACKGROUND There is still no definitive indication about the ideal point of time to perform bioimpedance analysis (BIA) in hemodialysis patients. Furthermore, the interpretation of data in this regard is difficult because there is still no comprehensive information about the fluctuations in BIA variables occurring in these subjects. The aim of this study was to assess BIA changes occurring in hemodialysis and specifically in the dry-weight state. METHODS We studied 27 anuric patients (20 males and 7 females; age 56.1 +/- 13.7 years) on chronic hemodialysis. Single-frequency BIA (R, resistance; Xc, reactance; and PhA, phase angle) was performed (1) before and at the end of hemodialysis (dialysis period); (2) 15, 30, 60, 90, and 120 minutes after hemodialysis (postdialysis period); and (3) 24, 48, and 68 hours after hemodialysis (interdialysis period). RESULTS Body weight decreased by 2.8 +/- 0.8 kg during hemodialysis, was unchanged during the postdialysis period, and progressively rose during the interdialysis period. At the same time, BIA variables significantly increased during hemodialysis (R, 453 +/- 74 and 542 +/- 98 ohm; Xc, 38 +/- 10 and 53 +/- 16 ohm; P < 0.05), remained stable over the 120-minute period after treatment (R, 538 +/- 94, 539 +/- 95, 538 +/- 94, 541 +/- 95, and 544 +/- 95 ohm; and Xc, 53 +/- 15, 53 +/- 15, 51 +/- 16, 52 +/- 16, and 52 +/- 16 ohm; NS), and subsequently declined [R, 471 +/- 79 (P= <0.05 vs. postdialysis), 449 +/- 71 (P= <0.05 vs. postdialysis), 424 +/- 68 (P= <0.05 vs. postdialysis) ohm; Xc, 42 +/- 13 (P= <0.05 vs. postdialysis), 37 +/- 10 (P= <0.05 vs. postdialysis), 34 +/- 13 (P= <0.05 vs. postdialysis) ohm]. The stability of BIA measures during postdialysis was confirmed by the constant relationship found between R/height and Xc/height. Also PhA increased after dialysis (4.8 +/- 1.1 degrees vs. 5.7 +/- 1.3 degrees, P < 0.05), was unchanged during the following 120 minutes and decreased in the interdialysis period (5.1 +/- 1.3 degrees, 4.8 +/- 1.0 degrees, and 4.5 +/- 1.1 degrees, P < 0.05). At the end of hemodialysis and during the postdialysis period total body water (TBW) estimated from BIA was similar on average to TBW calculated using Watson formulas (37.2 +/- 6.3 L vs. 36.2 +/- 5.7 L, NS). On the contrary, when patients were hyperhydrated BIA significantly overestimated the Watson's values. CONCLUSION In hemodialysis patients BIA variables fluctuate to a considerable extent (with the highest values immediately after hemodialysis), but remain constant and highly reproducible over the 120 minutes after the end of hemodialysis, that is, in a dry-weight state. Thus, taking into consideration that the point in time chosen for performing BIA is crucial to properly assess body composition, BIA can be appropriately performed at anytime during the postdialysis period, provided that hydration status does not change due to food or drink consumption.
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Reyes ZS, Bataclan FA, Nair PMC, Sankhla DK. Anuric unless catheterized. Saudi Med J 2004; 25:1503. [PMID: 15494836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Affiliation(s)
- Zenaida S Reyes
- Neonatal Unit, Child Health Department, Sultan Qaboos University Hospital, PO Box 38 Al-Khod 123, Muscat, Oman.
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Ijiri Y, Inoue T, Fukuda F, Suzuki K, Kobayashi T, Shibahara N, Takenaka H, Tanaka K. Dialyzability of the Antiepileptic Drug Zonisamide in Patients Undergoing Hemodialysis. Epilepsia 2004; 45:924-7. [PMID: 15270757 DOI: 10.1111/j.0013-9580.2004.30603.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The influence of hemodialysis on plasma zonisamide (ZNS) concentration has not been clarified. In this study, the dialyzability of ZNS during hemodialysis was investigated in four ZNS-treated women with systemic lupus erythematosus complicated by seizures. METHODS The total and unbound plasma concentrations of ZNS were measured before and after hemodialysis. The concentration of ZNS in the spent dialysate also was determined. RESULTS The reduction in plasma ZNS concentration after a 4.5-h hemodialysis was 52.0 +/- 7.6%, and the dialyzer (BLF-16GW) clearance of ZNS was 55.1 +/- 7.0 ml/min. Dosage was gradually increased up to 200 to 500 mg/day, and the seizures were controlled satisfactorily. CONCLUSIONS The plasma concentration of ZNS was reduced by approximately 50% during one session of dialysis. For patients undergoing daytime hemodialysis sessions every 2 or 3 days, the usual dosage of ZNS (4-8 mg/kg/day) may be prescribed once a day in the evening. If seizures occur after hemodialysis, a supplemental daily dose may be prescribed in the morning.
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Affiliation(s)
- Yoshio Ijiri
- Department of Pharmacy, Osaka Medical College Hospital, Osaka, Japan
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Jacobs F, Nicolaos G, Prieur S, Brivet F. Quinine dosage may not need to be reduced during continuous venovenous hemodiafiltration in severe anuric malaria. Clin Infect Dis 2004; 39:288-9. [PMID: 15307043 DOI: 10.1086/421782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Affiliation(s)
- Georgios Efstratiadis
- Department of Nephrology, Hippokration General Hospital, 50 Papanastasiou Street, 54642 Thessaloniki, Greece.
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