JournalTOCs

Archives of Clinical Nephrology
Number of Followers: 2

This is an Open Access Journal

Open Access journal
ISSN (Online) 2581-3870
Published by Peertechz

[75 journals]

Acute kidney infarction: Not so rare renal disease. A single-center
experience with endovascular fibrinolytic therapy
- Abstract: Renal Infarction (RI), a rare cause of renal damage characterized by the abrupt interruption of flow in the renal artery, is often recognized late or may even remain undiagnosed since symptoms are non-specific and may be confused with other pathologies, such as pyelonephritis or nephrolithiasis. In situ thrombosis and thromboembolism are the main causes, but often the real cause is, gf unrecognized. The disease is often underdiagnosed and the diagnosis of certainty can be established with ultrasonography Doppler of renal arteries or with second-level diagnostic tools (contrast-enhanced computer tomography, magnetic resonance with gadolinium, and renal scintigraphy) or third level tests (renal arteriography). The therapeutic approach depends on the cause of RI, from the time from onset of ischemia, from the presence of kidney function impairment, and may include systemic anticoagulant therapy, renal angioplasty with or without stenting, loco-regional endovascular fibrinolytic therapy or surgery, as the last chance. In literature, there are neither guidelines nor evidence about any treatment superiority. Here we describe a paradigmatic case in a 51-years-old man hospitalized because of sudden flank pain: the clinical picture, the high serum level. Moreover, we report our 7-years’ experience with 24 cases of RI, mean age 70 /±15 years, 14/24 men, 16/24 presented with hematuria, frequently associated with the history of CKD (16/24). Fifteen of them (62%) were classified as idiopathic and 9 of them were successfully treated with endovascular fibrinolytic treatment. A review of the literature is also provided.
  PubDate: 17 Feb, 2022
Cellular interorganelle crosstalk in health and disease states: A glimpse
on nephrology-related conditions
- Abstract: Cellular interorganelle crosstalk in medical sciences is a new discussion of mechanisms and pathways of physiological functions and pathogenesis of diseases. The organelles (“mitochondria”, nucleus, lysosome, endoplasmic reticulum, Golgi apparatus) are members of such functional units that are needed to perform specific tasks. Mitochondria are essential metabolic organelles in cells, but they also contribute to iron and calcium homeostasis, as well as in the regulation of apoptosis, and they are increasingly recognized as key signaling platforms. In the kidney, crosstalk between mitochondria with endoplasmic reticulum is at mitochondria-associated endoplasmic reticulum membrane in regulating calcium homeostasis. Another crosstalk between these organelles is about autophagic mechanisms. Autophagy is triggered in the kidney in response to acute kidney injury and supports against kidney injury. High glucose-induced reactive oxygen species can be produced by both enzymatic and nonenzymatic pathways. The nucleotide-binding domain and leucine-rich repeat (NLR) family or nucleotide-binding and oligomerization domain (NOD)-like receptors family pyrin domain containing 3 (NLRP3) inflammasome plays a role in inducing infectious defenses via inflammatory cytokines. The NLRP3 inflammasome is activated by the mitochondria-associated endoplasmic reticulum membrane. It has a role in nephrocalcinosis-related chronic kidney disease. This review article is a summary of interorganelle crosstalk in health and disease states, especially in kidney and nephrology-related conditions.
  PubDate: 13 May, 2022
Initial and long-term outcomes of Percutaneous Transluminal Angioplasty
for central venous stenosis or occlusion in chronic hemodialysis patients:
Analysis of 363 lesions in single center
- Abstract: The purpose of this study was to evaluate the initial and long-term outcomes of Percutaneous Transluminal Angioplasty (PTA) for central venous stenosis or occlusion in chronic hemodialysis patients. A total of 363 central venous lesions (277 stenosis and 86 occluded lesions) of 146 patients were enrolled and analyzed retrospectively; these included 130 de novo lesions and 233 restenosis lesions. The procedural success rate in our cohort was 97.0% (352/363 lesions); success rate for stenosis was significantly higher than that for occluded lesions (99.3% vs. 89.5%, P < 0.001). Complications during PTA procedures occurred in nine lesions (2.5%); however, there were no serious complications. A total of 120 stents were implanted for 111 lesions; the rate of stent placement for occluded lesions was significantly higher than that for stenosis lesions (68.8% vs. 18.4%, P < 0.001). The primary patency of de novo lesions was significantly higher than that of restenosis lesions (P = 0.0004); the assisted patency of de novo lesions at 12 and 36 months were 94.4% and 89.0%, respectively. There was no significant difference of primary patency between balloon angioplasty and stent placement for de novo lesions, however, primary patency after stent placement for restenosis lesions was significantly higher than that after balloon angioplasty (P = 0.001).In conclusion, PTA for central venous stenosis or occlusion was safe procedure with low rate of technical failure. The patency of vascular access in long-term was maintained by the repeated intervention. Stent placement could help prolong the patency period for restenosis lesions.
  PubDate: 30 Apr, 2021
A comprehensive survey on optimal components of extracellular matrix for
kidney development and function
- Abstract: The extracellular matrix (ECM) is an essential component of the network nearby the cells to guarantee their physiological function and homeostasis. Choosing the most appropriate ECM for mammalian cells, including human cells, is one of the most important criteria for qualifying the in vitro experiments of tissue engineering and functional analyses. While most previous studies examined several ECM components to optimization of ECMs proper for many mammalian cells, a comprehensive study with an integrated conclusion in this scope is still lacking.c The current review will discuss the factors which should be taken into account for designing or optimizing an optimal ECM for the development and maintenance of the kidney tissues. Besides, the components of the previously reported ECMs were compared to each other.
  PubDate: 29 May, 2021
Crystalline nephropathy due to adenine phosphoribosyl transferase
deficiency as a cause of renal allograft dysfunction
- Abstract: APRT deficiency is a rare but under recognized genetic disease. Recurrent urolithiasis and DHA nephropathy are the two clinical manifestations of APRT deficiency and diagnosis can be made at any age and recurs after renal transplant. Allopurinol is the cornerstone in preventing recurrence. APRT activity assay and genetic testing are useful for confirmation of diagnosis, for family screening and in difficult cases of urolithias or crystalline nephropathy.
  PubDate: 18 Jan, 2021
Retrospective observational analysis of ferric pyrophosphate citrate
(triferic®) administered via dialysate. Experience at a single facility
over 2 years
- Abstract: Background: Ferric pyrophosphate citrate (FPC, Triferic®) is a unique form of iron therapy that is indicated to maintain iron balance and hemoglobin concentration in adult hemodialysis patients. We conducted an analysis of observational data from an independent dialysis facility that has administered FPC via the central delivery system to all patients in the facility over a 2‑year period to determine if FPC would offer pharmacoeconomic benefits over the current anemia management protocol that was used at the dialysis facility.Methods: FPC was administered in the dialysate to 61 patients via the central delivery system from first quarter 2017 through fourth quarter 2018.Anonymized data were obtained from the Electronic Medical Record of the dialysis facility. Data were summarized descriptively. The analysis used the last quarter (3 months) of data before initiation of FPC as baseline values. Data were aggregated by quarter and presented as total administered dose, average dose per patient or as average per patient‑year exposure. Results: FPC reduced the need for supplemental intravenous iron use by an average of 74% over the 2-year observation period and reduced the amount of erythropoietin‑stimulating agents needed to maintain hemoglobin levels within the target range of 10.0 to 11.0 g/dL. Small mean improvements in quality of life were observed, as assessed by the 36-item Kidney Disease Quality of Life Questionnaire (KDQoL-36™) mental and physical component scores. As compared with US Renal Data System (USRDS) data, all-cause hospitalizations, infection‑related hospitalizations, and deaths were reduced by approximately 50% after initiation of FPC.Conclusions: Implementation of FPC as an iron maintenance therapy for all patients in a chronic hemodialysis center may result in improvements in anemia management and patient outcomes and in pharmacoeconomic benefits to the dialysis center.
  PubDate: 17 Jun, 2021
High incidence rate of human herpesvirus 6 infection after Bendamustine,
Cytarabine, Etoposide and Melphalan conditioning regimen: A monocentric
and retrospective study
- Abstract: Background: Following shortage of Carmustine, BeEAM regimen (Bendamustine, Etoposide, Cytarabine and Melphalan) was used before autologous transplant in relapsed/refractory lymphoma patients. We evaluated safety and efficacy of BeEAM compared to BEAM.Patients and methods: Ninety consecutive patients receiving BeEAM (30pts) (Bendamustine 100, 120 or 200 mg/m²/d) or BEAM (60 pts) were retrospectively analyzed. Results: In the BEAM group, 68% had NHL and 32% HL compared to 87% and 13% in the BeEAM group (p = 0,014). Pts were in CR or PR at time of transplant. There was no difference regarding hematologic recovery and transfusion requirements. Highest dose of Bendamustine were associated with grade ≥ 2 kidney toxicity. We observed a significant higher incidence of symptomatic HHV-6 infection (53.3% versus 8.3%), digestive toxicity (36.6% versus 15%) and prolonged hospitalization (25 versus 21 days) with BeEAM. After a median follow up of 61 and 49 months for BEAM and BeEAM, 5y-OS and PFS (76% versus 67% and 56% versus 70%) and TRM (0% versus 3%) were not different.Conclusions: BeEAM with the highest doses of Bendamustine was associated with increased risk of HHV-6 infection, longer duration of hospitalization, higher rate of digestive toxicity and increased acute kidney failure while survival was comparable.
  PubDate: 14 Jun, 2021
Impact of Diabetes Mellitus on Renal transplant outcome
- Abstract: Diabetes Mellitus (DM) is a potent risk factor for post-transplant cardiovascular complications and infections. Management of diabetes and its complications in renal transplant recipients is a challenging task. This is a frequently encountered predicament in transplant setups. An erratic glycemic control during dialysis is a predictor of poor graft and patient outcomes after kidney transplantation. Literature review reveals majority studies explaining post-transplant diabetes and its role in graft and patient survival. However, a wide range of opinion exists about the impact of pre-transplant DM on transplant outcomes. Measurement of HbA1c levels is a significant tool for assessment of glycemic control. A target HbA1c level of <7% is recommended for diabetic patients irrespective of presence or absence of Chronic Kidney Disease (CKD). However, diabetic patients with CKD are at risk of hypoglycemia owing to decreased insulin metabolism so it is safe to keep HbA1c levels between 7-8% in this population.Immunosuppressive medications have a strong contributory role in deterioration of glycemic control. So, it is imperative to achieve strict pre-transplant diabetes control in order to avoid post-transplant complications. Post-transplant diabetes mellitus (PTDM) has been a subject of a large number of trials and is not only considered a serious metabolic complication but also a predisposing factor of diabetic nephropathy in transplanted kidney.
  PubDate: 12 Oct, 2021
Hyperuricemia in Renal patients: Treat or not to treat
- Abstract: Hyperuricemia management in chronic kidney disease is a challenging task. We encounter this dilemma on regular basis. Kidney disease patients have wide range (CKD population, Hemodialysis & peritoneal dialysis cohort and renal transplant patients). In clinical practice wide range of opinions exists. This dubious area intrigued us to look into it. Looking into available published data majority of studies are observational and few are randomized control trials. All studies favor that high uric acid level has accelerated effect on CKD progression. Controversy is on its management, whether by treating it we are able to slow down CKD progression or not. Data supports that CKD progression is not slowed down but needs more studies to give conclusive answer. In dialysis and renal transplant patients studies showed inverse relationship of high uric levels with all-cause mortality. However, in peritoneal dialysis data suggests linear relationship of hyperuricemia with mortality. A pro as well as anti-oxidant effect of uric acid has been discussed in literature. Variable cut off for hyperuricemia has been used but more census is on 7 mg/dl. Symptomatic gout definitely needs uric acid lowering therapy but in asymptomatic hyperuricemia no conclusion so far. There is paucity of data in maintenance dialysis and renal transplant patients.
  PubDate: 06 Aug, 2021
The airborne dilemma
- Abstract: In December 2019, there were 44 cases of an atypical pneumonia found to be related to a novel coronavirus, SARS-CoV-2. The disease was classified as a global health emergency one month later and reached pandemic proportion by March 11, 2020. By October 2020, it had killed over 1,000,000 people. By April 2021, there were nearly 3 million deaths. Not only has this virus been costly in terms of life but has had lasting side effects. It has been difficult to contain, sometimes resulting in overloading of hospital critical care services and disruption of regular care. It has also devastated the economy, particularly sectors related to tourism and transportation. Even the Summer Olympics were postponed. We have had severe pandemics throughout our history, but the last one this devastating was the Spanish Influenza of 1918. The world was unprepared for this onslaught.
  PubDate: 06 Apr, 2021
Evaluating plasma Digoxin concentration after an intravenous loading dose
in patients with renal failure
- Abstract: Background: Digoxin is a medication of Glycoside family which is commonly prescribed for patients with atrial fibrillation, atrial flutter, and heart failure. With a narrow therapeuticlevel(0.5–2 ng/mL), careful monitoring of digoxin blood level is necessary. Symptoms of digoxin toxicity include nausea, vomiting, visual changes, altered mental status, hyperkalemia, and cardiovascular collapse. As renal failure decreases the clearance of digoxin, and impaired renal function is common in heart failure, this population is at higher risk of toxicity. Methods & materials: In this prospective study, patients with chronic kidney disease- nondialysis (CKD-ND) who were admitted with heart failure or atrial fibrillation at university hospital, were enrolled. Digoxin-naive patients were treated with a 10 mcg/kg intravenous digoxin loading dose. Serum digoxin level was measured 6 to 12 hours after the last loading dose. Patients were followed for 48 hours for signs of toxicity. Correlation between therapeutic digoxin level and degree of renal failure was evaluated. The effect of serum electrolyte (magnesium, calcium, and potassium) concentration on digoxin level was determined. Pregnant women were excluded from study.Results: From 2018 to 2020, 87 CKD patients, (60 (69%) men and 27 (31%) women) aged from 31 to 92 years old, with a mean age of 70.51 ± 14.06 years were admitted to the cardiac unit. Near 80% of the cohort were CKD stage 3 and 4 patients. About half of patients had digoxin levels in therapeutic range (45 cases = 51.7%), followed by 24.1% with supra therapeutic and the other 24.1% with toxic levels. There was significant relationship between GFR and serum digoxin concentration (p-value = 0.038); the lower the GFR was, the higher was the digoxin level and also between serum creatinine and digoxin level (p value: .04). Serum digoxin concentration had significant correlation with serum magnesium level (p-value = 0.006).Conclusion: this study demonstrated that monitoring plasma Digoxin concentration after an intravenous loading dose in patients with renal failure can be very helpful to prevent digoxin toxicity. The lower the GFR was, the higher the digoxin level and the risk for toxicity if the bolus and even maintenance do not monitor meticulously.
  PubDate: 04 Jun, 2021