Clinical Queries: Nephrology最新文献

The management of acute kidney injury (AKI) in critically sick patients in the intensive care unit entails the use of renal replacement therapy. There has been considerable experience in continuous renal replacement therapy (CRRT) in this setting. Recently there has been increased interest in slow low efficiency dialysis (SLED) to treat these patients. In this review, the technical considerations, clinical and practical advantages of SLED are discussed.

Peritoneal dialysis unlike hemodialysis has a number of factors which affect the dialysis delivery and hence influence the outcome. Assessment of adequacy of dialysis therefore has an important role in managing these patients and providing appropriate PD prescription. Like in hemodialysis patients majority of studies and guidelines recommend small-solute clearances as marker of PD adequacy. However, the outcome in these patients has not been consistently linked to small-solute clearance and therefore adequacy assessment should be performed in a holistic manner, with due importance given to clinical examination, quality of life assessment and biochemical parameters in addition to measurement of solute clearances.

Hypertensive disorders of pregnancy form the deadly triad along with hemorrhage and infection that contribute greatly to maternal morbidity and mortality rates. It complicates about 5–10% of pregnancies worldwide. Despite decades of research, it is still an enigma that how pregnancy incites or aggravates hypertension. Development of strategies to prevent and treat the disorder has been challenging due to an incomplete understanding of the pathogenesis. This article reviews the current aspect in its etiology and management of this disorder.

Hypertension is rare in children, and usually associated with underlying renal, endocrine or cardiac pathology. However the prevalence of essential hypertension is rising in older children in association with a worldwide increase in obesity. Pediatric hypertension is known to track into adulthood and is thereby associated with long term cardiovascular morbidities. In addition it can cause acute complications like left ventricular failure and hypertensive encephalopathy and chronic progressive vascular damage in several organ systems.

Children at risk of hypertension require regular monitoring of blood pressure using appropriate equipment and correct cuff sizes. Hypertensive children should be investigated thoroughly for an underlying etiology. Patients should also be screened for evidence of end organ damage. Measurements of arterial stiffness are in a stage of investigation and not yet available for routine clinical use. Management includes family education, institution of lifestyle changes primarily aimed at weight reduction and pharmacotherapy.

The elderly are the most rapidly growing demographic subset of world population. Not only does the prevalence of hypertension increase with age, but elderly patients also have increased prevalence of co-morbidities like coronary artery disease, congestive heart failure, chronic renal impairment, stroke and cognitive decline. Managing hypertension in elderly patients represents a therapeutic challenge for physicians and till recently the overall benefits of treating these patients remained unclear. The following review focuses on salient features of hypertension in the elderly population along with reappraisal of blood pressure management principles in this population.

Renovascular disease is an entity which leads to hypertension as well as to ischemic nephropathy if the gradual process continues unabated. It may be discovered incidentally in an asymptomatic individual during imaging studies and more frequently due to its associated aftermath like accelerated hypertension and on workup of unexplained chronic kidney disease. Various advanced diagnostic modalities aid in diagnosis of this entity with their merits and associated limitations. Strategies to manage include mainly medical management and revascularization as per recommendations and where indications exist.