Pub Date : 2023-01-05DOI: 10.3390/kidneydial3010005
N. Lameire
This study reviews the renal aspects of diuretic resistance occurring in diuretic treatment, mostly with loop diuretics of congestive heart failure. A short discussion on the different classes of diuretics, including the recently introduced sodium-glucose transporter 2 inhibitors, and their mechanism of action in the nephron is provided, followed by a summary of recent data discussing the different causes and pathophysiological mechanisms of diuretic resistance. The major cause of diuretic resistance appears to be localized within the distal tubule. Traditionally, the concept of compensatory post-diuretic sodium reabsorption (CPDSR) was considered the major cause of diuretic resistance; however, recent studies have disputed this traditional concept and demonstrated that patients with congestive heart failure are in constant sodium-avid state. Finally, the different options of therapeutic strategies, combining different classes of diuretics are summarized.
{"title":"Renal Mechanisms of Diuretic Resistance in Congestive Heart Failure","authors":"N. Lameire","doi":"10.3390/kidneydial3010005","DOIUrl":"https://doi.org/10.3390/kidneydial3010005","url":null,"abstract":"This study reviews the renal aspects of diuretic resistance occurring in diuretic treatment, mostly with loop diuretics of congestive heart failure. A short discussion on the different classes of diuretics, including the recently introduced sodium-glucose transporter 2 inhibitors, and their mechanism of action in the nephron is provided, followed by a summary of recent data discussing the different causes and pathophysiological mechanisms of diuretic resistance. The major cause of diuretic resistance appears to be localized within the distal tubule. Traditionally, the concept of compensatory post-diuretic sodium reabsorption (CPDSR) was considered the major cause of diuretic resistance; however, recent studies have disputed this traditional concept and demonstrated that patients with congestive heart failure are in constant sodium-avid state. Finally, the different options of therapeutic strategies, combining different classes of diuretics are summarized.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46486743","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 : 2023-01-04DOI: 10.3390/kidneydial3010004
K. Nitta, N. Hanafusa, K. Akiyama, Yuki Kawaguchi, Ken Tsuchiya
Chronic kidney disease—mineral and bone disorder (CKD-MBD) is a systemic disorder that increases the risk of morbidity and mortality in dialysis patients. CKD-MBD is highly prevalent in dialysis patients, and appropriate treatment is important for improving their outcomes. Inorganic phosphate, fibroblast growth factor 23, parathyroid hormone, and calciprotein particles are markers for critical components and effectors of CKD-MBD, and higher circulating levels of these markers are linked to cardiovascular diseases. In this short review, we focus on the pathogenesis and management of CKD-MBD in CKD patients, especially those on dialysis therapy, and discuss the prospects for improving the management in CKD patients, including those on dialysis.
{"title":"Chronic Kidney Disease—Mineral and Bone Disorder (CKD-MBD), from Bench to Bedside","authors":"K. Nitta, N. Hanafusa, K. Akiyama, Yuki Kawaguchi, Ken Tsuchiya","doi":"10.3390/kidneydial3010004","DOIUrl":"https://doi.org/10.3390/kidneydial3010004","url":null,"abstract":"Chronic kidney disease—mineral and bone disorder (CKD-MBD) is a systemic disorder that increases the risk of morbidity and mortality in dialysis patients. CKD-MBD is highly prevalent in dialysis patients, and appropriate treatment is important for improving their outcomes. Inorganic phosphate, fibroblast growth factor 23, parathyroid hormone, and calciprotein particles are markers for critical components and effectors of CKD-MBD, and higher circulating levels of these markers are linked to cardiovascular diseases. In this short review, we focus on the pathogenesis and management of CKD-MBD in CKD patients, especially those on dialysis therapy, and discuss the prospects for improving the management in CKD patients, including those on dialysis.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70156016","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 : 2023-01-03DOI: 10.3390/kidneydial3010003
G. London, M. Safar, B. Pannier
Arterial dysfunction is major risk factor for cardiovascular complications, and arterial stiffness is an independent risk factor in end-stage renal disease patients. As the distance from the heart increases, arterial stiffness (pulse wave velocity) becomes progressively more marked. This generates a centrifugal stiffness gradient, which leads to partial, continuous local wave reflections, which in turn attenuate the transmission of pulsatile pressure into the microcirculation, thus limiting the potentially deleterious outcomes both upstream (on the heart: left-ventricular hypertrophy and coronary perfusion) and downstream (on the renal and cerebral microcirculation: reduced glomerular filtration and impaired cognitive functions). The impact of arterial aging is greater on the aorta and central capacitive arteries, and it is characterized by a loss or reversal of the physiological stiffness gradient between central and peripheral arteries. Recently, however, in contrast to observations on the aorta, several studies have shown less pronounced, absent, or even negative associations between muscular peripheral arteries and age–stiffness relationships, which may be associated with a decrease in or reversal of the stiffness gradient. These findings point to a potential benefit of assessing the muscular peripheral arteries to predict the risk of cardiovascular disease and suggest that reversal of the stiffness gradient may be an independent risk factor for all-cause mortality.
{"title":"The Age–Stiffness Relationships of Elastic and Muscular Arteries in a Control Population and in End-Stage Renal Disease Patients","authors":"G. London, M. Safar, B. Pannier","doi":"10.3390/kidneydial3010003","DOIUrl":"https://doi.org/10.3390/kidneydial3010003","url":null,"abstract":"Arterial dysfunction is major risk factor for cardiovascular complications, and arterial stiffness is an independent risk factor in end-stage renal disease patients. As the distance from the heart increases, arterial stiffness (pulse wave velocity) becomes progressively more marked. This generates a centrifugal stiffness gradient, which leads to partial, continuous local wave reflections, which in turn attenuate the transmission of pulsatile pressure into the microcirculation, thus limiting the potentially deleterious outcomes both upstream (on the heart: left-ventricular hypertrophy and coronary perfusion) and downstream (on the renal and cerebral microcirculation: reduced glomerular filtration and impaired cognitive functions). The impact of arterial aging is greater on the aorta and central capacitive arteries, and it is characterized by a loss or reversal of the physiological stiffness gradient between central and peripheral arteries. Recently, however, in contrast to observations on the aorta, several studies have shown less pronounced, absent, or even negative associations between muscular peripheral arteries and age–stiffness relationships, which may be associated with a decrease in or reversal of the stiffness gradient. These findings point to a potential benefit of assessing the muscular peripheral arteries to predict the risk of cardiovascular disease and suggest that reversal of the stiffness gradient may be an independent risk factor for all-cause mortality.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49196206","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 : 2023-01-01DOI: 10.3390/kidneydial3010002
Ivy Moore, P. Byrne, N. Ilic, Jenny Heng-Chen Chen, K. Lambert
(1) Background: Pain is a prevalent and debilitating symptom associated with kidney failure. However, the impact of pain on quality of life remains unclear. We aimed to identify the prevalence, severity and characteristics of people undertaking dialysis impacted by pain and explore the lived experience of pain (2) Methods: A cross-sectional survey was administered to people undertaking haemodialysis or via telephone to those undertaking peritoneal and home haemodialysis in a single tertiary centre. Open-ended questions were analysed using thematic analysis. (3) Results: Responses were received from 131 participants (response rate 66.8%). Most were undergoing haemodialysis (87.0%). Pain was present in 92% (n = 121) of patients with 62% (n = 81) reporting pain as severe to excruciating. Common sites of pain were joints, muscle cramps, headaches, fistula pain, non-specific back pain and neuropathy. The overarching theme from the thematic analysis was that pain was a “debilitating and accepted burden” (4) Conclusions: Pain is highly prevalent, severe and debilitating in those on dialysis. There is a need for health care providers to be proactive and attentive to the management of pain. More research is needed to identify effective treatment approaches to decrease pain burden and improve the quality of life in those with kidney failure.
{"title":"The Prevalence and Lived Experience of Pain in People Undertaking Dialysis","authors":"Ivy Moore, P. Byrne, N. Ilic, Jenny Heng-Chen Chen, K. Lambert","doi":"10.3390/kidneydial3010002","DOIUrl":"https://doi.org/10.3390/kidneydial3010002","url":null,"abstract":"(1) Background: Pain is a prevalent and debilitating symptom associated with kidney failure. However, the impact of pain on quality of life remains unclear. We aimed to identify the prevalence, severity and characteristics of people undertaking dialysis impacted by pain and explore the lived experience of pain (2) Methods: A cross-sectional survey was administered to people undertaking haemodialysis or via telephone to those undertaking peritoneal and home haemodialysis in a single tertiary centre. Open-ended questions were analysed using thematic analysis. (3) Results: Responses were received from 131 participants (response rate 66.8%). Most were undergoing haemodialysis (87.0%). Pain was present in 92% (n = 121) of patients with 62% (n = 81) reporting pain as severe to excruciating. Common sites of pain were joints, muscle cramps, headaches, fistula pain, non-specific back pain and neuropathy. The overarching theme from the thematic analysis was that pain was a “debilitating and accepted burden” (4) Conclusions: Pain is highly prevalent, severe and debilitating in those on dialysis. There is a need for health care providers to be proactive and attentive to the management of pain. More research is needed to identify effective treatment approaches to decrease pain burden and improve the quality of life in those with kidney failure.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46618425","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 : 2022-12-22DOI: 10.3390/kidneydial3010001
K. Mori, M. Kurajoh, M. Inaba, M. Emoto
Advances in medicine have resulted in increased longevity, which has consequently led to unexpected geriatric syndromes, such as frailty and sarcopenia. Patients with end-stage kidney disease, especially those receiving dialysis treatment, often show characteristic reductions in body protein and energy storage, termed protein energy wasting (PEW). Therefore, maintenance of nutritional condition has a key role in defending against both geriatric syndromes and PEW, which share several components in elderly individuals undergoing hemodialysis. To counteract the development of an undesirable condition, nutritional evaluation is indispensable. In addition to simple measurements of body mass index, and serum albumin and creatinine, a composite nutritional assessment including a malnutrition inflammation score is useful, although subjective elements are included and a well-trained examiner is required. On the other hand, the geriatric nutritional risk index and nutritional risk index for Japanese hemodialysis patients (NRI-JH) are objective tools, and easy to use in clinical settings. Undernutrition is closely related to infectious events and the results of an infection are often serious in elderly patients, even those with survival, with large medical costs incurred. Together with appropriate nutritional evaluation, it is necessary to clarify the underlying relationship of PEW with infection for improvement of prognosis in affected elderly individuals.
{"title":"Multifaceted Nutritional Disorders in Elderly Patients Undergoing Dialysis","authors":"K. Mori, M. Kurajoh, M. Inaba, M. Emoto","doi":"10.3390/kidneydial3010001","DOIUrl":"https://doi.org/10.3390/kidneydial3010001","url":null,"abstract":"Advances in medicine have resulted in increased longevity, which has consequently led to unexpected geriatric syndromes, such as frailty and sarcopenia. Patients with end-stage kidney disease, especially those receiving dialysis treatment, often show characteristic reductions in body protein and energy storage, termed protein energy wasting (PEW). Therefore, maintenance of nutritional condition has a key role in defending against both geriatric syndromes and PEW, which share several components in elderly individuals undergoing hemodialysis. To counteract the development of an undesirable condition, nutritional evaluation is indispensable. In addition to simple measurements of body mass index, and serum albumin and creatinine, a composite nutritional assessment including a malnutrition inflammation score is useful, although subjective elements are included and a well-trained examiner is required. On the other hand, the geriatric nutritional risk index and nutritional risk index for Japanese hemodialysis patients (NRI-JH) are objective tools, and easy to use in clinical settings. Undernutrition is closely related to infectious events and the results of an infection are often serious in elderly patients, even those with survival, with large medical costs incurred. Together with appropriate nutritional evaluation, it is necessary to clarify the underlying relationship of PEW with infection for improvement of prognosis in affected elderly individuals.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47454457","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 : 2022-12-12DOI: 10.3390/kidneydial2040056
F. Pallotti, Claire Queffeulou, M. Bellal, Bastien Jean-Jacques, A. Gac, V. Châtelet, A. Boyer, V. Gueutin
Background: Thrombotic microangiopathies (TMAs) can be induced by drugs. Recent works have indicated proteasome inhibitors, including carfilzomib, as a possible new causative agent. Although the physiopathology and management of carfilzomib-induced TMA are still unknown, eculizumab seems to be efficient. Results: We report a clinical case of TMA during carfilzomib treatment for multiple myeloma, possibly triggered by a concomitant influenza infection, suggesting a multi-hit process. Histologic analysis of the kidney biopsy proved renal TMA. Eculizumab allowed rapid and long-lasting renal and hematologic recovery. We enriched our work with a systemic review of published cases of carfilzomib-induced TMA treated by eculizumab. Twelve patients were included, all of whom presented acute renal failure and nine of them required hemodialysis. Eculizumab led to TMA resolution in eleven patients and complete renal recovery with hemodialysis withdrawal for seven of them within a month. One patient died from multiple myeloma progression. Two patients presented inter-current viral infection. Soluble complement fragment Bb and C5b9s were found in two patients and genetic benign variant of Factor H (CFH3–CFH1) in four. Conclusion: Our results suggest that eculizumab is effective in carfilzomib-induced TMA, which could support its inclusion as a treatment option. Further studies are required to clarify its physiopathology, complement role, and management.
{"title":"Carfilzomib-Induced Thrombotic Microangiopathy Treated with Eculizumab: A Case Report and Rapid Literature Review","authors":"F. Pallotti, Claire Queffeulou, M. Bellal, Bastien Jean-Jacques, A. Gac, V. Châtelet, A. Boyer, V. Gueutin","doi":"10.3390/kidneydial2040056","DOIUrl":"https://doi.org/10.3390/kidneydial2040056","url":null,"abstract":"Background: Thrombotic microangiopathies (TMAs) can be induced by drugs. Recent works have indicated proteasome inhibitors, including carfilzomib, as a possible new causative agent. Although the physiopathology and management of carfilzomib-induced TMA are still unknown, eculizumab seems to be efficient. Results: We report a clinical case of TMA during carfilzomib treatment for multiple myeloma, possibly triggered by a concomitant influenza infection, suggesting a multi-hit process. Histologic analysis of the kidney biopsy proved renal TMA. Eculizumab allowed rapid and long-lasting renal and hematologic recovery. We enriched our work with a systemic review of published cases of carfilzomib-induced TMA treated by eculizumab. Twelve patients were included, all of whom presented acute renal failure and nine of them required hemodialysis. Eculizumab led to TMA resolution in eleven patients and complete renal recovery with hemodialysis withdrawal for seven of them within a month. One patient died from multiple myeloma progression. Two patients presented inter-current viral infection. Soluble complement fragment Bb and C5b9s were found in two patients and genetic benign variant of Factor H (CFH3–CFH1) in four. Conclusion: Our results suggest that eculizumab is effective in carfilzomib-induced TMA, which could support its inclusion as a treatment option. Further studies are required to clarify its physiopathology, complement role, and management.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42266828","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 : 2022-12-01DOI: 10.3390/kidneydial2040054
O. Phan, N. Joki
The pathogenesis of vascular calcification (VC) in diabetes mellitus (DM) has not been completely elucidated. VC often occur in patients with DM and chronic kidney disease (CKD). The incidence of VC in diabetic patients is more frequent than in nondiabetic patients, which is an important cause of cardiovascular (CV) morbidity and mortality. VC is a progressive transformation of the vascular wall; it results from an active and complex phenomenon affecting particularly the vascular smooth muscle cells (VSMCs). It leads to a change in the phenotype of the VSMCs towards an osteoblastic-like phenotype. DM is associated with specific risk factors in addition to hyperglycemia, such as increased oxidative stress, proinflammatory state, hypertension, and chronic kidney disease (CKD) promoting endothelial dysfunction. This article provides an overview and update of the pathophysiological data on the role of DM in VC progression.
{"title":"Vascular Calcification in Diabetic Kidney Disease","authors":"O. Phan, N. Joki","doi":"10.3390/kidneydial2040054","DOIUrl":"https://doi.org/10.3390/kidneydial2040054","url":null,"abstract":"The pathogenesis of vascular calcification (VC) in diabetes mellitus (DM) has not been completely elucidated. VC often occur in patients with DM and chronic kidney disease (CKD). The incidence of VC in diabetic patients is more frequent than in nondiabetic patients, which is an important cause of cardiovascular (CV) morbidity and mortality. VC is a progressive transformation of the vascular wall; it results from an active and complex phenomenon affecting particularly the vascular smooth muscle cells (VSMCs). It leads to a change in the phenotype of the VSMCs towards an osteoblastic-like phenotype. DM is associated with specific risk factors in addition to hyperglycemia, such as increased oxidative stress, proinflammatory state, hypertension, and chronic kidney disease (CKD) promoting endothelial dysfunction. This article provides an overview and update of the pathophysiological data on the role of DM in VC progression.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42834235","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 : 2022-12-01Epub Date: 2022-12-07DOI: 10.3390/kidneydial2040055
Kristin P Kim, Caitlin E Williams, Christopher A Lemmon
Renal fibrosis is a hallmark of end-stage chronic kidney disease. It is characterized by increased accumulation of extracellular matrix (ECM), which disrupts cellular organization and function within the kidney. Here, we review the bi-directional interactions between cells and the ECM that drive renal fibrosis. We will discuss the cells involved in renal fibrosis, changes that occur in the ECM, the interactions between renal cells and the surrounding fibrotic microenvironment, and signal transduction pathways that are misregulated as fibrosis proceeds. Understanding the underlying mechanisms of cell-ECM crosstalk will identify novel targets to better identify and treat renal fibrosis and associated renal disease.
{"title":"Cell-Matrix Interactions in Renal Fibrosis.","authors":"Kristin P Kim, Caitlin E Williams, Christopher A Lemmon","doi":"10.3390/kidneydial2040055","DOIUrl":"10.3390/kidneydial2040055","url":null,"abstract":"<p><p>Renal fibrosis is a hallmark of end-stage chronic kidney disease. It is characterized by increased accumulation of extracellular matrix (ECM), which disrupts cellular organization and function within the kidney. Here, we review the bi-directional interactions between cells and the ECM that drive renal fibrosis. We will discuss the cells involved in renal fibrosis, changes that occur in the ECM, the interactions between renal cells and the surrounding fibrotic microenvironment, and signal transduction pathways that are misregulated as fibrosis proceeds. Understanding the underlying mechanisms of cell-ECM crosstalk will identify novel targets to better identify and treat renal fibrosis and associated renal disease.</p>","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10081509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9378946","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}
Pub Date : 2022-11-10DOI: 10.3390/kidneydial2040053
O. A. Orozco-Guillén, Virgilia Soto-Abram, Bernardo Moguel-González, M. Madero, G. Piccoli
The differential diagnosis between new occurrence or revelation of chronic kidney diseases in pregnancy and hypertensive disorders of pregnancy is not easy, and the presence of a hypertensive disorder superimposed on a glomerular disease is even more challenging, as this case exemplifies. A 29-year-old woman was referred with HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome at the end of her pregnancy. Immediately after cesarean delivery, she developed anuria, unexplained by blood loss or hypotension, and in the absence of known nephrotoxic drugs. While the laboratory features of HELLP rapidly resolved, AKI persisted, and the finding of high-level proteinuria was the hint leading to diagnosis of a glomerular disease (focal segmental glomerulosclerosis, FSGS), later proven by kidney biopsy. This case, reporting on the rare association between HELLP and FSGS, offers the opportunity to discuss the role of proteinuria, hypertension, and in the differential diagnosis of pregnancy-related acute kidney injury (pAKI).
{"title":"An Unusual Cause of Acute Kidney Injury in Pregnancy: Beware of HELLP Look-Alikes","authors":"O. A. Orozco-Guillén, Virgilia Soto-Abram, Bernardo Moguel-González, M. Madero, G. Piccoli","doi":"10.3390/kidneydial2040053","DOIUrl":"https://doi.org/10.3390/kidneydial2040053","url":null,"abstract":"The differential diagnosis between new occurrence or revelation of chronic kidney diseases in pregnancy and hypertensive disorders of pregnancy is not easy, and the presence of a hypertensive disorder superimposed on a glomerular disease is even more challenging, as this case exemplifies. A 29-year-old woman was referred with HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome at the end of her pregnancy. Immediately after cesarean delivery, she developed anuria, unexplained by blood loss or hypotension, and in the absence of known nephrotoxic drugs. While the laboratory features of HELLP rapidly resolved, AKI persisted, and the finding of high-level proteinuria was the hint leading to diagnosis of a glomerular disease (focal segmental glomerulosclerosis, FSGS), later proven by kidney biopsy. This case, reporting on the rare association between HELLP and FSGS, offers the opportunity to discuss the role of proteinuria, hypertension, and in the differential diagnosis of pregnancy-related acute kidney injury (pAKI).","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44259954","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 : 2022-11-03DOI: 10.3390/kidneydial2040051
R. Matsuzawa, Daisuke Kakita
An aging population and the prevalence of lifestyle-related ailments have led to a worldwide increase in the rate of chronic kidney disease requiring renal replacement therapy. The mean age of people requiring dialysis has been rising, and Japanese patients are aging more rapidly than those in the United States and Europe. Compared to people with normal kidney function, those undergoing hemodialysis are at increased risk of sarcopenia or frailty and serious health problems that limit access to kidney transplantation and lead to adverse health outcomes such as functional dependence, hospitalization, and death in patients on dialysis treatment. The Japanese Society of Renal Rehabilitation, established in 2011, published a clinical practice guideline for renal rehabilitation in 2019. Although the concept has become widely known among kidney health providers in recent years, efforts have still not focused on routine clinical care for patients with chronic kidney disease. In this review, the theory and clinical application of renal rehabilitation for patients undergoing daily hemodialysis were investigated.
{"title":"Renal Rehabilitation—Its Theory and Clinical Application to Patients Undergoing Daily Dialysis Therapy","authors":"R. Matsuzawa, Daisuke Kakita","doi":"10.3390/kidneydial2040051","DOIUrl":"https://doi.org/10.3390/kidneydial2040051","url":null,"abstract":"An aging population and the prevalence of lifestyle-related ailments have led to a worldwide increase in the rate of chronic kidney disease requiring renal replacement therapy. The mean age of people requiring dialysis has been rising, and Japanese patients are aging more rapidly than those in the United States and Europe. Compared to people with normal kidney function, those undergoing hemodialysis are at increased risk of sarcopenia or frailty and serious health problems that limit access to kidney transplantation and lead to adverse health outcomes such as functional dependence, hospitalization, and death in patients on dialysis treatment. The Japanese Society of Renal Rehabilitation, established in 2011, published a clinical practice guideline for renal rehabilitation in 2019. Although the concept has become widely known among kidney health providers in recent years, efforts have still not focused on routine clinical care for patients with chronic kidney disease. In this review, the theory and clinical application of renal rehabilitation for patients undergoing daily hemodialysis were investigated.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48106393","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}
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