Pub Date : 2018-12-31DOI: 10.23937/2572-3286.1510039
Gupta Ena, Sujith Ravi, Sidhu Nimrita, C. M. Martinez, B. Michael, Awsare Bharat
Introduction: Many studies have shown the association between acute kidney injury (AKI) and morbidity and mortality in the Intensive Care Unit (ICU). Traditional measures of AKI, such as serum creatinine and urine output, fail to show dynamic changes in renal function. A feasibility study was performed to evaluate the Nephrocheck® test system which comprises of two biomarkers (Insulin-like growth factor binding protein 7 (IGFBP7) and tissue inhibitor of metalloproteinases-2 (TIMP-2)) to screen for patients at risk for AKI in the ICU and to guide management. Methods: Patients were enrolled between November 2016 and March 2017 with respiratory failure or sepsis with no pre-existing elevation in the creatinine admitted to the ICU. In patients with an initial Nephrocheck® value ≥ 0.3, the primary team was notified and a kidney protective bundle was suggested. A repeat Nephrocheck® test was performed within 24 hours in those patients with initial value ≥ 0.3. Results: Twenty patients were enrolled. Six (30%) patients developed AKI during first week of ICU stay. All six patients had initial Nephrocheck® values ≥ 0.3 that subsequently increased with the second Nephrocheck® test at 24 hours. Seven patients had normal Nephrocheck® values on admission and did not develop AKI. Interestingly, seven patients who had initial Nephrocheck® values ≥ 0.3 that decreased at 24 hours did not develop AKI. Conclusion: The trend of the Nephrocheck® values was more significant than the initial value for the development of AKI. The Nephrocheck® test may be used as an early indicator of development of AKI. However, further studies are needed to determine if nephron-protective interventions can be helpful in mitigating this risk.
{"title":"Utility of Trend of Nephrocheck® (IGFBP7 × TIMP-2) Biomarker for Early Identification of Acute Kidney Injury in Critically Ill Patients with Sepsis or Respiratory Failure","authors":"Gupta Ena, Sujith Ravi, Sidhu Nimrita, C. M. Martinez, B. Michael, Awsare Bharat","doi":"10.23937/2572-3286.1510039","DOIUrl":"https://doi.org/10.23937/2572-3286.1510039","url":null,"abstract":"Introduction: Many studies have shown the association between acute kidney injury (AKI) and morbidity and mortality in the Intensive Care Unit (ICU). Traditional measures of AKI, such as serum creatinine and urine output, fail to show dynamic changes in renal function. A feasibility study was performed to evaluate the Nephrocheck® test system which comprises of two biomarkers (Insulin-like growth factor binding protein 7 (IGFBP7) and tissue inhibitor of metalloproteinases-2 (TIMP-2)) to screen for patients at risk for AKI in the ICU and to guide management. Methods: Patients were enrolled between November 2016 and March 2017 with respiratory failure or sepsis with no pre-existing elevation in the creatinine admitted to the ICU. In patients with an initial Nephrocheck® value ≥ 0.3, the primary team was notified and a kidney protective bundle was suggested. A repeat Nephrocheck® test was performed within 24 hours in those patients with initial value ≥ 0.3. Results: Twenty patients were enrolled. Six (30%) patients developed AKI during first week of ICU stay. All six patients had initial Nephrocheck® values ≥ 0.3 that subsequently increased with the second Nephrocheck® test at 24 hours. Seven patients had normal Nephrocheck® values on admission and did not develop AKI. Interestingly, seven patients who had initial Nephrocheck® values ≥ 0.3 that decreased at 24 hours did not develop AKI. Conclusion: The trend of the Nephrocheck® values was more significant than the initial value for the development of AKI. The Nephrocheck® test may be used as an early indicator of development of AKI. However, further studies are needed to determine if nephron-protective interventions can be helpful in mitigating this risk.","PeriodicalId":73669,"journal":{"name":"Journal of clinical nephrology and renal care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42358453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-20DOI: 10.23937/2572-3286.1510040
H. Hasnain, N. Afif, S. Nicholas
Renal artery dissections (RADs) are lesions that disrupt vessels that primarily occur in patients with a known history of hypertension and caused by stenosis or enlargement of the renal artery typically due to underlying connective tissue disorders. However, RADs may occur spontaneously from trauma and no previous history of hypertension. Here, we report a rare case of bilateral isolated spontaneous RADs that characteristically occurs in healthy males. A 52-year-old male presented with left lower quadrant abdominal pain and renal insufficiency. Two years prior, he had experienced a similar episode of pain on the contralateral side, which was due to an infarct of the right kidney. On this admission, a computed tomography angiogram confirmed a new infarct of the left kidney, with dissection of a branch of the renal artery supplying the upper lobe. Work-up for cardiovascular, hematologic, radiographic or connective tissue causes was negative. We postulate that both RADs were potentially associated with the rapid twisting and turning of the abdominal area on a daily basis required for his occupation as an air traffic controller. The patient was treated with a renin angiotensin system inhibitor. After one year, both RADs had significantly improved and his renal function increased by ~23%. Isolated RAD may be associated with consistent or long-term activities that require rapid twisting and turning of the abdominal area. If left untreated, this may result in malignant hypertension, bilateral dissections, or renal ischemia. To avoid misdiagnosis; we provide a comprehensive review of the typical presentation and necessary assessment and management.
{"title":"Case Report: 52-Year-Old Male with Right Upper Quadrant Abdominal Pain","authors":"H. Hasnain, N. Afif, S. Nicholas","doi":"10.23937/2572-3286.1510040","DOIUrl":"https://doi.org/10.23937/2572-3286.1510040","url":null,"abstract":"Renal artery dissections (RADs) are lesions that disrupt vessels that primarily occur in patients with a known history of hypertension and caused by stenosis or enlargement of the renal artery typically due to underlying connective tissue disorders. However, RADs may occur spontaneously from trauma and no previous history of hypertension. Here, we report a rare case of bilateral isolated spontaneous RADs that characteristically occurs in healthy males. A 52-year-old male presented with left lower quadrant abdominal pain and renal insufficiency. Two years prior, he had experienced a similar episode of pain on the contralateral side, which was due to an infarct of the right kidney. On this admission, a computed tomography angiogram confirmed a new infarct of the left kidney, with dissection of a branch of the renal artery supplying the upper lobe. Work-up for cardiovascular, hematologic, radiographic or connective tissue causes was negative. We postulate that both RADs were potentially associated with the rapid twisting and turning of the abdominal area on a daily basis required for his occupation as an air traffic controller. The patient was treated with a renin angiotensin system inhibitor. After one year, both RADs had significantly improved and his renal function increased by ~23%. Isolated RAD may be associated with consistent or long-term activities that require rapid twisting and turning of the abdominal area. If left untreated, this may result in malignant hypertension, bilateral dissections, or renal ischemia. To avoid misdiagnosis; we provide a comprehensive review of the typical presentation and necessary assessment and management.","PeriodicalId":73669,"journal":{"name":"Journal of clinical nephrology and renal care","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46690444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-30DOI: 10.23937/2572-3286.1510035
Lourenço Bruna S, Nascimento Marcos A, Siqueira Vicente N, Draibe Sérgio A, Mello Marco T, Tufik Sérgio, Canziani Maria EF, Higa Elisa MS
Purpose: Chronic kidney disease is a public health problem that causes severe complications to the patient. The major damage is the loss of muscle mass, with a consequent reduction in the functional capacity that is associated with hypertension and increased oxidative stress. This study aimed to evaluate the effect of intra-dialysis resistance training on the hemodynamic parameters, oxidative stress and quality of life in patients with chronic kidney disease. Methods: The volunteers underwent a physical training during the hemodialysis sessions. The hemodynamic parameters, oxidative stress, the quality of life, the functional autonomy and one repetition maximum (1 RM) were evaluated. Results: The data did not show alterations in the hemodynamic parameters, nitric oxide or lipid peroxidation after 12 weeks of resistance training. We observed significant differences in the quality of life in the following dimensions of the Kidney Disease Quality of Life Short Form (KDQOL-SFTM) questionnaire after 12 weeks of resistance training: Functional capacity, physical aspects, vitality, social and emotional aspects and mental health (P < 0.05). The time needed to execute the functional autonomy test was improved after the resistance training, and strength was increased significantly in all the exercises, as assessed by the 1 RM test (P < 0.001). Conclusion: In conclusion, after 12 weeks, the intra-dialysis resistance training did not modify the hemodynamic parameters neither the oxidative stress profile of these patients, but improved their quality of life. These data show that intra-dialysis resistance training is safe and can provide many physical and emotional benefits to chronic kidney disease patients.
{"title":"Effects of Intra-Dialysis Resistance Training in Hemodynamic Parameters, Oxidative Stress and Health-Related Quality of Life in Patients with Chronic Kidney Disease","authors":"Lourenço Bruna S, Nascimento Marcos A, Siqueira Vicente N, Draibe Sérgio A, Mello Marco T, Tufik Sérgio, Canziani Maria EF, Higa Elisa MS","doi":"10.23937/2572-3286.1510035","DOIUrl":"https://doi.org/10.23937/2572-3286.1510035","url":null,"abstract":"Purpose: Chronic kidney disease is a public health problem that causes severe complications to the patient. The major damage is the loss of muscle mass, with a consequent reduction in the functional capacity that is associated with hypertension and increased oxidative stress. This study aimed to evaluate the effect of intra-dialysis resistance training on the hemodynamic parameters, oxidative stress and quality of life in patients with chronic kidney disease. Methods: The volunteers underwent a physical training during the hemodialysis sessions. The hemodynamic parameters, oxidative stress, the quality of life, the functional autonomy and one repetition maximum (1 RM) were evaluated. Results: The data did not show alterations in the hemodynamic parameters, nitric oxide or lipid peroxidation after 12 weeks of resistance training. We observed significant differences in the quality of life in the following dimensions of the Kidney Disease Quality of Life Short Form (KDQOL-SFTM) questionnaire after 12 weeks of resistance training: Functional capacity, physical aspects, vitality, social and emotional aspects and mental health (P < 0.05). The time needed to execute the functional autonomy test was improved after the resistance training, and strength was increased significantly in all the exercises, as assessed by the 1 RM test (P < 0.001). Conclusion: In conclusion, after 12 weeks, the intra-dialysis resistance training did not modify the hemodynamic parameters neither the oxidative stress profile of these patients, but improved their quality of life. These data show that intra-dialysis resistance training is safe and can provide many physical and emotional benefits to chronic kidney disease patients.","PeriodicalId":73669,"journal":{"name":"Journal of clinical nephrology and renal care","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41433407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-30DOI: 10.23937/2572-3286.1510034
Ebad Chaudhry Adeel, G. Alan, J ConlonPeter
We report affective utilization of continuous veno-venous hemofiltration for removal of phenobarbital in a patient who took twice amount of fatal dose and was hemodynamically stable. Historically treatment includes supportive care, activated charcoal and urinary alkalinisation along with the application of extracorporeal treatments such as charcoal haem perfusion or hemodialysis and continuous veno-venous hemodiafiltration are affective treatment for removal of drug. Early initiation of extracorporeal treatment and increasing blood flow rate effectively reduced half life of drug and improved patient outcome with fatal poisoning. known time. He was brought unconscious had GCS of 3 blood pressure 120/75 pulse 85 per minutes’ respiratory rate 12 per minutes’ and temperature of 36.5 °C was intubated and ventilated and transferred to intensive care unit. His medical background history includes bipolar disorder, deliberate self harm. His initial investigation showed positive blood and urine toxicology screen for barbiturates only and phenobarbital level of 160.5 mg/L, others investigation including full blood count, renal profile, liver function, arterial blood gases, calcium, phosphate, amylase, creatinine kinase and coagulation screen within normal limits (Table 1). His electrocardiogram showed prolonged QT. He remained hemodynamically stable without any inotropic support was started on supportive management with intravenous fluid and activated charcoal in intensive care unit as renal profile and acid base status remained within fair range with no evidence of renal failure. His repeat phenobarbital level after 48 hours was 221.8 mg/L likely due to redistribution of drug.
{"title":"Effective Role of CVVH in Fatal Phenobarbital Overdose Clearance: A Case Report","authors":"Ebad Chaudhry Adeel, G. Alan, J ConlonPeter","doi":"10.23937/2572-3286.1510034","DOIUrl":"https://doi.org/10.23937/2572-3286.1510034","url":null,"abstract":"We report affective utilization of continuous veno-venous hemofiltration for removal of phenobarbital in a patient who took twice amount of fatal dose and was hemodynamically stable. Historically treatment includes supportive care, activated charcoal and urinary alkalinisation along with the application of extracorporeal treatments such as charcoal haem perfusion or hemodialysis and continuous veno-venous hemodiafiltration are affective treatment for removal of drug. Early initiation of extracorporeal treatment and increasing blood flow rate effectively reduced half life of drug and improved patient outcome with fatal poisoning. known time. He was brought unconscious had GCS of 3 blood pressure 120/75 pulse 85 per minutes’ respiratory rate 12 per minutes’ and temperature of 36.5 °C was intubated and ventilated and transferred to intensive care unit. His medical background history includes bipolar disorder, deliberate self harm. His initial investigation showed positive blood and urine toxicology screen for barbiturates only and phenobarbital level of 160.5 mg/L, others investigation including full blood count, renal profile, liver function, arterial blood gases, calcium, phosphate, amylase, creatinine kinase and coagulation screen within normal limits (Table 1). His electrocardiogram showed prolonged QT. He remained hemodynamically stable without any inotropic support was started on supportive management with intravenous fluid and activated charcoal in intensive care unit as renal profile and acid base status remained within fair range with no evidence of renal failure. His repeat phenobarbital level after 48 hours was 221.8 mg/L likely due to redistribution of drug.","PeriodicalId":73669,"journal":{"name":"Journal of clinical nephrology and renal care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47232105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01Epub Date: 2017-02-14DOI: 10.23937/2572-3286.1510021
C K Liu, J Milton, F-C Hsu, K M Beavers, V Yank, T Church, J D Shegog, S Kashaf, S Nayfield, A Newman, R S Stafford, B Nicklas, D E Weiner, R A Fielding
Background: Because chronic kidney disease (CKD) is associated with muscle wasting, older adults with CKD are likely to have physical function deficits. Physical activity can improve these deficits, but whether CKD attenuates the benefits is unknown. Our objective was to determine if CKD modified the effect of a physical activity intervention in older adults.
Methods: This is an exploratory analysis of the LIFE-P study, which compared a 12-month physical activity program (PA) to a successful aging education program (SA) in older adults. CKD was defined as a baseline eGFR < 60 mL/min/1.73 m2. We examined the Short Physical Performance Battery (SPPB) at baseline, 6 and 12 months. Secondary outcomes included serious adverse events (SAE) and adherence to intervention frequency. Linear mixed models were adjusted for age, sex, diabetes, hypertension, CKD, intervention, site, visit, baseline SPPB, and interactions of intervention and visit and of intervention, visit, and baseline CKD.
Results: The sample included 368 participants. CKD was present in 105 (28.5%) participants with a mean eGFR of 49.2 ± 8.1 mL/min/1.73 m2. Mean SPPB was 7.38 ± 1.41 in CKD participants; 7.59 ± 1.44 in those without CKD (p = 0.20). For CKD participants in PA, 12-month SPPBs increased to 8.90 (95% CI 8.32, 9.47), while PA participants without CKD increased to 8.40 (95% CI 8.01, 8.79, p = 0.43). For CKD participants in SA, 12-month SPPBs increased to 7.67 (95% CI 7.07, 8.27), while participants without CKD increased to 8.12 (95% CI 7.72, 8.52, p = 0.86). Interaction between CKD and intervention was non-significant (p = 0.88). Number and type of SAEs were not different between CKD and non-CKD participants (all p > 0.05). In PA, adherence for CKD participants was 65.5 ± 25.4%, while for those without CKD was 74.0 ± 22.2% (p = 0.12).
Conclusion: Despite lower adherence, older adults with CKD likely derive clinically meaningful benefits from physical activity with no apparent impact on safety, compared to those without CKD.
{"title":"The Effect of Chronic Kidney Disease on a Physical Activity Intervention: Impact on Physical Function, Adherence, and Safety.","authors":"C K Liu, J Milton, F-C Hsu, K M Beavers, V Yank, T Church, J D Shegog, S Kashaf, S Nayfield, A Newman, R S Stafford, B Nicklas, D E Weiner, R A Fielding","doi":"10.23937/2572-3286.1510021","DOIUrl":"10.23937/2572-3286.1510021","url":null,"abstract":"<p><strong>Background: </strong>Because chronic kidney disease (CKD) is associated with muscle wasting, older adults with CKD are likely to have physical function deficits. Physical activity can improve these deficits, but whether CKD attenuates the benefits is unknown. Our objective was to determine if CKD modified the effect of a physical activity intervention in older adults.</p><p><strong>Methods: </strong>This is an exploratory analysis of the LIFE-P study, which compared a 12-month physical activity program (PA) to a successful aging education program (SA) in older adults. CKD was defined as a baseline eGFR < 60 mL/min/1.73 m<sup>2</sup>. We examined the Short Physical Performance Battery (SPPB) at baseline, 6 and 12 months. Secondary outcomes included serious adverse events (SAE) and adherence to intervention frequency. Linear mixed models were adjusted for age, sex, diabetes, hypertension, CKD, intervention, site, visit, baseline SPPB, and interactions of intervention and visit and of intervention, visit, and baseline CKD.</p><p><strong>Results: </strong>The sample included 368 participants. CKD was present in 105 (28.5%) participants with a mean eGFR of 49.2 ± 8.1 mL/min/1.73 m<sup>2</sup>. Mean SPPB was 7.38 ± 1.41 in CKD participants; 7.59 ± 1.44 in those without CKD (p = 0.20). For CKD participants in PA, 12-month SPPBs increased to 8.90 (95% CI 8.32, 9.47), while PA participants without CKD increased to 8.40 (95% CI 8.01, 8.79, p = 0.43). For CKD participants in SA, 12-month SPPBs increased to 7.67 (95% CI 7.07, 8.27), while participants without CKD increased to 8.12 (95% CI 7.72, 8.52, p = 0.86). Interaction between CKD and intervention was non-significant (p = 0.88). Number and type of SAEs were not different between CKD and non-CKD participants (all p > 0.05). In PA, adherence for CKD participants was 65.5 ± 25.4%, while for those without CKD was 74.0 ± 22.2% (p = 0.12).</p><p><strong>Conclusion: </strong>Despite lower adherence, older adults with CKD likely derive clinically meaningful benefits from physical activity with no apparent impact on safety, compared to those without CKD.</p>","PeriodicalId":73669,"journal":{"name":"Journal of clinical nephrology and renal care","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10056048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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