Current Issue : January - March Volume : 2013 Issue Number : 1 Articles : 6 Articles
Background: Currently used biomarkers for acute kidney injury (AKI), namely Ngal, SCr, and BUN, are\r\ninadequate for timely detection of AKI in preterm infants.\r\nMethods: Nuclear magnetic resonance (NMR) spectroscopy-based metabolic profiling was conducted on urines\r\nfrom 20 preterm infants to determine if novel metabolic biomarkers could be identified for early detection of AKI.\r\nUrines were collected from every patient each day for the first 14 days of life. NMR spectra were measured for all\r\nurines and metabolic profiling analysis conducted.\r\nResults: One metabolite, carnitine, increased significantly in urines of three extremely low birth weight (ELBW)\r\ninfants starting on day five of life. The three affected infants either received prolonged antibiotic treatment, extended\r\ntreatment with indomethacin, or both. One ELBW patient who received both treatments and reached the highest\r\nurinary carnitine level died on day 10 of life due to localized gut perforation complicated by suspected AKI.\r\nConclusions: It was concluded that carnitine increased in the three neonates in part due to antibiotic- and/\r\nor indomethacin-induced AKI. It is hypothesized that combined antibiotic and indomethacin treatment promoted\r\nAKI resulting in reduced proximal renal tubule reabsorption of carnitine and that �Ÿ-lactam antibiotics blocked renal\r\ncarnitine uptake by human organic cation transporter, hOCTN2....
Calciphylaxis, a rare, life threatening disease, usually observed in patients with chronic kidney disease and characterised by typical skin lesions ââ?¬â?? violaceous, reticulate areas of cutaneous necrosis particularly in the extremities, raised calcium phosphorous product, elevated parathyroid hormone level, histopathologically skin biopsies shows mural calcification affecting small arterioles and radiographic evidence of blood vessel and soft-tissue calcification. Calciphylaxis is a small-vessel vasculopathy, reported to occur in about 1-4% of haemodialysis patients. Disease is associated with a high mortality which ranges from 60ââ?¬â??80% and relates to wound infection, sepsis and organ failure. Prolonged hyperphosphatemia and/or elevated calcium phosphorus products, Protein malnutrition, warfarin use and hypercoagulable states, such as protein C and/or protein S deficiency are associated with increased risk of the disease. Clinically, many dermatologic conditions resemble the skin lesions of Calciphylaxis but can be discern by careful clinical evaluation of patient and histopathological examination of skin biopsy. Different therapeutic agents have been reported for the treatment of this condition with variable results. Therapeutic goals are guided by controlling levels of parathyroid hormone, calcium, phosphate, and the calcium-phosphate product within the normal range. A high index of suspicion and an active multidisciplinary management approach, with rigorous attention to wound care and prevention of sepsis, are vital steps in the management of these patients. In this overview, we discuss the pathophysiology, clinical features, risk factors, and diagnosis and management issues relating to Calciphylaxis. This review is of interest to Medical specialist- specially to Dermatologist and Nephrologists for early identification of disease and therapeutic intervention....
Several studies have shown that non-adherence is a common and increasing problem regarding those with chronic illnesses, including chronic kidney disease (CKD) patients undergoing hemodialysis (HD). The present study aimed to investigate the influence of sociodemographic features as well as beliefs about medicines on adherence to medication treatment among HD patients.\r\n \r\nA sample of 168 individuals was recruited from six General Hospitals in the broader area of Athens, consisting of patients undergoing in - centre HD. Measurements were conducted with the following instruments: the Medication Adherence Rating Scale (MARS) and the Beliefs about Medicines Questionnaire (BMQ).\r\n \r\nMedication adherence was associated positively with family (r= 0.24, p= 0.00) and work status (r= 0.26, p= 0.00) as well as BMQ - concern (r= 0.19, p= 0.02).\r\n \r\nThe present study demonstrates the importance of sociodemographic characteristics in understanding medication adherence in HD patients as well as the contribution of beliefs about medicines....
\r\n \r\n\r\n \Z \Z !\" \r\nCenter, University of Urmia School of Veterinary Medicine with a history of progressive bilateral abdominal distention\r\nsince birth. Two days after birth, the animal had mental dullness, a poor growth rate comparable to a twin, and\r\nprogressive bilateral abdominal distension. On physical examination, the animal was in poor body condition and had\r\na mass palpable in the cranial ventral abdomen (The abdomen was tight, round, and painful on palpation) and also\r\nlamb was bright, low awareness and responsive. Temperature (37�°C), pulse (154 beats per minute), and respiration\r\n(55 breaths per minute) and weighing 3.5 kg were elevated. Histopathological examinations revealed that bilaterally\r\nenlarged kidneys were characterized by renal tubules at all levels of the nephron unit and extended into the cranial\r\nventral abdomen. Glomeruli were sporadic, small and often hypoplastic or atrophic, located within a dilated Bowmanâ��s\r\ncapsule. Renal cysts were usually bilateral, occurred in cortex and medulla and varied from less than 0.5 mm to over\r\n5 mm in diameter. Cysts were lined by epithelial cells of nephron origin. Macroscopic and microscopic studies were\r\nsimilar to autosomal recessive polycystic kidney disease in humans and to previous reports of juvenile polycystic\r\ndisorders in several animal species. Consequently, a polycystic kidney disease was diagnosed in Herrik lamb...
\r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \Z\Z \r\n \r\n\r\n \r\n \r\n \r\n \Z \r\n \r\n \r\n \r\n \r\n \Z\r\n \r\nin 1984. During these early years, the predominant etiology of kidney disease in HIV was recognized as HIVassociated\r\nnephropathy (HIVAN), an aggressive form of kidney disease with a high rate of progression to end-stage\r\nrenal disease (ESRD). Subsequently, with the widespread use of combination antiretroviral therapy (cART), there\r\nwas a dramatic decrease in the incidence of ESRD attributed to HIV/AIDS. Although the incidence of HIV-related\r\nESRD has plateaued in the last 15 years, the prevalence has continued to increase because of improved survival.\r\nAvailable prevalence estimates do not include HIV-infected individuals with comorbid ESRD, although there is\r\ngrowing evidence that the epidemiology of kidney disease in the HIV-infected population has changed. This article\r\nreviews the impact of risk factors such as race, diabetes mellitus, hypertension, hepatitis C virus coinfection, and\r\nthe chronic use of cART on the changing epidemiology of HIV-related kidney disease. Additionally in this review, we\r\npropose potential areas of translational research that will help to further characterize HIV-related kidney disease in\r\nthe 21st century....
The incidence of acute kidney injury (AKI, previously referred to as acute renal failure) is reaching epidemic proportions. In this situation, early intervention can significantly improve the prognosis. Despite significant improvements in therapeutics, the mortality and morbidity associated with AKI remain high. A major reason for this is the lack of early markers for AKI, akin to troponins in acute myocardial disease, and hence an unacceptable delay in initiating therapy. Unfortunately, serum creatinine (SCr) is a delayed and unreliable indicator of AKI. The authors have previously shown that urine neutrophil gelatinase-associated lipocalin (NGAL) is an early predictive biomarker of acute kidney injury (AKI) after cardiopulmonary bypass (CPB). In this study, the evidence for the role of NGAL measurements in AKI after CPB is explored. The emerging utility of standardized clinical platforms for reliable measurement of NGAL urine is discussed. In a prospective study with 303 adults undergoing CPB were enrolled and serial urine NGAL measurements were obtained. The primary outcome was AKI, defined as a >50% increase in SCr. AKI developed in 75 patients (25%), but the diagnosis using Scr was delayed by 2 to 3 d after CPB. In contrast, mean urine NGAL levels increased 4-fold within 2 h after CPB and remained significantly elevated for the duration of the study. The 2-h postoperative urine NGAL levels strongly correlated with change in creatinine (r =0.56, p<0.001), duration of AKI (r =0.47, p<0.001), and length of hospital stay (r =0.39, p<0.001). The 12-h urine NGAL levels stromgly correlated with death (r=0.41, p<0.004). Urine NGAL is an early predictive biomarker of AKI severity and mortality after CPB. It will be important in future studies to validate the sensitivity and specificity of NGAL concentration measurements in clinical samples from large cohorts and from multiple clinical situations. Such studies will be facilitated by the anticipated widespread availability of standardized commercial tools in the near future....
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