Current Issue : July - September Volume : 2014 Issue Number : 3 Articles : 7 Articles
Bilateral congenital hydronephosis was described in a tiger cub; clinically the animal was dull since three days prior to death. Grossly enlargement of both kidneys with abnormal retention of urine in renal pelvis was observed. Slight dilation of renal pelvis, calyces, bulging of renal crest was noticed. In medulla cystic spaces communicated with the pelvis were observed. On detailed examination, stricture was noticed in both ureters. Histopaholgical examination revealed slight atrophy of medulla and cortex. Cystic dilation of renal tubules with atrophy of renal tubular epithelium was evident. The tubules were separated by a diffuse cortical fibrosis. Based on the gross, histopaholgical findings the case was identified as bilateral congenital hydronephrosis....
Background: Monitoring of volatile organic compounds (VOCs) in exhaled breath shows great potential as a non-invasive\nmethod for assessing hemodialysis efficiency. In this work we aim at identifying and quantifying of a wide range of VOCs\ncharacterizing uremic breath and blood, with a particular focus on species responding to the dialysis treatment.\nMethods: Gas chromatography with mass spectrometric detection coupled with solid-phase microextraction as\npre-concentration method.\nResults: A total of 60 VOCs were reliably identified and quantified in blood and breath of CKD patients.\nExcluding contaminants, six compounds (isoprene, dimethyl sulfide, methyl propyl sulfide, allyl methyl sulfide,\nthiophene and benzene) changed their blood and breath levels during the hemodialysis treatment.\nConclusions: Uremic breath and blood patterns were found to be notably affected by the contaminants from\nthe extracorporeal circuits and hospital room air. Consequently, patient exposure to a wide spectrum of volatile\nspecies (hydrocarbons, aldehydes, ketones, aromatics, heterocyclic compounds) is expected during hemodialysis.\nWhereas highly volatile pollutants were relatively quickly removed from blood by exhalation, more soluble ones\nwere retained and contributed to the uremic syndrome. At least two of the species observed (cyclohexanone\nand 2-propenal) are uremic toxins. Perhaps other volatile substances reported within this study may be toxic\nand have negative impact on human body functions. Further studies are required to investigate if VOCs\nresponding to HD treatment could be used as markers for monitoring hemodialysis efficiency....
Background: Patients on chronic dialysis are at increased risk of vitamin D deficiency. In observational studies\nplasma 25-hydroxyvitamin D (p-25(OH) D) levels are inversely correlated with plasma BNP and adverse cardiovascular\noutcomes. Whether a causal relation exists has yet to be established. The aim of this study was to test the hypothesis\nthat cholecalciferol supplementation improves cardiac function and reduces blood pressure (BP) and pulse wave\nvelocity (PWV) in patients on chronic dialysis.\nMethods: In a randomized, placebo-controlled, double-blind study, we investigated the effect of 75 Ã?µg (3000 IU)\ncholecalciferol daily for 6 months, in patients on chronic dialysis. We performed two-dimensional echocardiography,\nwith doppler and tissue-doppler imaging, 24-h ambulatory BP (24-h BP), PWV, augmentation index (AIx), central BP\n(cBP) and brain natriuretic peptide (BNP) measurements at baseline and after 6 months.\nResults: Sixty-four patients were allocated to the study. Fifty dialysis patients with a mean age of 68 years (range:\n46ââ?¬â??88) and baseline p-25(OH) D of 28 (20;53) nmol/l completed the trial. Cholecalciferol increased left ventricular (LV)\nvolume, but had no impact on other parameters regarding LV structure or left atrial structure. LV systolic function, LV\ndiastolic function, PWV, cBP, AIx and BNP were not changed in placebo or cholecalciferol group at follow-up. 24-h BP\ndecreased significantly in placebo group and tended to decrease in cholecalciferol group without any difference\nbetween treatments.\nConclusion: Six months of cholecalciferol treatment in patients on chronic dialysis did not improve 24-h BP, arterial\nstiffness or cardiac function....
Background: No consensus exists on how to define abnormally rapid deterioration in renal function (Rapid\nProgression, RP). We developed an operational definition of RP in HIV-positive persons with baseline estimated\nglomerular filtration rate (eGFR) >90 ml/min/1.73 m2 (using Cockcroft Gault) in the Data Collection on Adverse\nEvents of Anti-HIV Drugs (D:A:D) study from 2004 to 2011.\nMethods: Two definitions were evaluated; RP definition A: An average eGFR decline (slope) =5 ml/min/1.73 m2/\nyear over four years of follow-up with =3 eGFR measurements/year, last eGFR <90 ml/min/1.73 m2 and an absolute\ndecline =5 ml/min/1.73 m2/year in two consecutive years. RP definition B: An absolute annual decline =5 ml/min/\n1.73 m2/year in each year and last eGFR <90 ml/min/1.73 m2. Sensitivity analyses were performed considering two\nand three years� follow-up. The percentage with and without RP who went on to subsequently develop incident\nchronic kidney disease (CKD; 2 consecutive eGFRs <60 ml/min/1.73 m2 and 3 months apart) was calculated.\nResults: 22,603 individuals had baseline eGFR =90 ml/min/1.73 m2. 108/3655 (3.0%) individuals with =4 years�\nfollow-up and =3 measurements/year experienced RP under definition A; similar proportions were observed when\nconsidering follow-up periods of three (n=195/6375; 3.1%) and two years (n=355/10756; 3.3%). In contrast under RP\ndefinition B, greater proportions experienced RP when considering two years (n=476/10756; 4.4%) instead of three\n(n=48/6375; 0.8%) or four (n=15/3655; 0.4%) years� follow-up. For RP definition A, 13 (12%) individuals who\nexperienced RP progressed to CKD, and only (21) 0.6% of those without RP progressed to CKD (sensitivity 38.2%\nand specificity 97.4%); whereas for RP definition B, fewer RP individuals progressed to CKD.\nConclusions: Our results suggest using three years� follow-up and at least two eGFR measurements per year is most\nappropriate for a RP definition, as it allows inclusion of a reasonable number of individuals and is associated with\nthe known risk factors. The definition does not necessarily identify all those that progress to incident CKD, however,\nit can be used alongside other renal measurements to early identify and assess those at risk of developing CKD.\nFuture analyses will use this definition to identify other risk factors for RP, including the role of antiretrovirals....
ESRD is rare; its treatment with dialysis or transplantation is very costly. Interventions to lessen morbidity and cost of care after beginning of dialysis are extremely optional. Drug-related problems (DRPs) are a main source of hospital admissions. One study stated 28% of hospital admissions being due to drug-related problems. Insufficient patient history information is the next leading cause of stated error with 24% of error being accredited to lack of information about the patient. Identification and resolution of DRPs can ensue through delivery of pharmaceutical care. Establishment of clinical pharmacy service/pharmaceutical care to dialysis patients is a cost-effective way to identify, resolve and avoid DRPs. Medication reviews for dialysis patients are composite to accomplish due to multiple medications, multiple indications, frequent dose changes, multiple health care providers and patient adherence concerns. Preceding research has confirmed that multidisciplinary clinics in chronic disease management increase patient outcomes. Establishment of such a service in the outpatient hospital setting overwhelms the issues concerning to pharmacists’ access to patients medical and laboratory data, however additional prescribing for clinical pharmacists working in the hospital outpatient clinics would save the choice of this pharmacists’ role for the future....
Background: Chronic kidney disease (CKD) is a progressive and usually irreversible disease. Different types of\noutcomes are of interest in the course of CKD such as time-to-dialysis, transplantation or decline of the glomerular\nfiltration rate (GFR). Statistical analyses aiming at investigating the association between these outcomes and risk\nfactors raise a number of methodological issues. The objective of this study was to give an overview of these\nissues and to highlight some statistical methods that can address these topics.\nMethods: A literature review of statistical methods published between 2002 and 2012 to investigate risk factors\nof CKD outcomes was conducted within the Scopus database. The results of the review were used to identify\nimportant methodological issues as well as to discuss solutions for each type of CKD outcome.\nResults: Three hundred and four papers were selected. Time-to-event outcomes were more often investigated than\nquantitative outcome variables measuring kidney function over time. The most frequently investigated events in\nsurvival analyses were all-cause death, initiation of kidney replacement therapy, and progression to a specific value\nof GFR. While competing risks were commonly accounted for, interval censoring was rarely acknowledged when\nappropriate despite existing methods. When the outcome of interest was the quantitative decline of kidney\nfunction over time, standard linear models focussing on the slope of GFR over time were almost as often used\nas linear mixed models which allow various numbers of repeated measurements of kidney function per patient.\nInformative dropout was accounted for in some of these longitudinal analyses.\nConclusions: This study provides a broad overview of the statistical methods used in the last ten years for\ninvestigating risk factors of CKD progression, as well as a discussion of their limitations. Some existing potential\nalternatives that have been proposed in the context of CKD or in other contexts are also highlighted....
Background: Previous studies have shown that treatment with ergocalciferol in patients with CKD stage 3 + 4 is\nnot effective with less than 33% of patients achieving a 25-OH vitamin D target of >30 ng/ml. The aim of this study\nwas to test the response to cholecalciferol in CKD. We attempted to replete 25-OH vitamin D to a target level of\n40ââ?¬â??60 ng/ml using the response to treatment and PTH suppression as an outcome measure.\nMethods: This retrospective cohort study identified patients (Stages 2ââ?¬â??5 and Transplant) from 2001ââ?¬â??2010 who\nregistered at the Chronic Kidney Disease Clinic. Patients received cholecalciferol 10,000 IU capsules weekly as initial\ntherapy. When levels above 40 ng/ml were not achieved, doses were titrated up to a maximum of 50,000 IU\nweekly. Active vitamin D analogs were also used in some Stage 4ââ?¬â??5 CKD patients per practice guidelines. Patients\nreaching at least one level of 40 ng/mL were designated RESPONDER, and if no level above 40 ng/mL they were\ndesignated NON-RESPONDER. Patients were followed for at least 6 months and up to 5 years.\nResults: 352 patients were included with a mean follow up of 2.4 years. Of the CKD patients, the initial 25-OH\nvitamin D in the NON-RESPONDER group was lower than the RESPONDER group (18 vs. 23 ng/ml) (p = 0.03).\nAmong all patients, the initial eGFR in the RESPONDER group was significantly higher than the NON-RESPONDER\ngroup (36 vs. 30 ml/min/1.73 m2) (p < 0.001). Over time, the eGFR of the RESPONDER group stabilized or increased\n(p < 0.001). Over time, the eGFR in the NON-RESPONDER group decreased toward a trajectory of ESRD. Proteinuria\ndid not impact the response to 25-OH vitamin D replacement therapy. There were no identifiable variables\nassociated with the response or lack of response to cholecalciferol treatment.\nConclusions: CKD patients treated with cholecalciferol experience treatment resistance in raising vitamin D levels\nto a pre-selected target level. The mechanism of vitamin D resistance remains unknown and is associated with\nprogressive loss of eGFR. Proteinuria modifies but does not account for the vitamin D resistance....
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