Pub Date : 2023-02-24DOI: 10.26420/austinjnephrolhypertens.2023.1104
Lim Wl, Duarte Ttp, Nava Lf, E. M. Mcs
Objective: Verify the effects of intensified and usual clinical nursing monitoring on the quality of life and sedentary lifestyle of hypertensive and diabetic patients in primary care. Method: A quantitative and quasi-experimental study of time series. The sample this study consisted in 85 users allocated in control (n=45) and experimental (n=40) groups. The intervention was a nursing consultation with biochemical monitoring program. Results: With the monitoring, laboratory variables in experimental group were controlled, such as serum creatinine (0.82 – 0.79 mg/dL). The control group included 6 (26.09%) patients with renal dysfunction (p=0.001). Sedentary lifestyle was reduced in the experimental group (15.00% to 0.00%). The psychological domain of quality of life presented a better perception in the group without renal dysfunction, when compared to the users with renal dysfunction (80.8 ± 0.19 vs 51.8 ± 0.21, p=0.013). Conclusion: Results proved to be relevant for the Nursing assistance practice with reduction of sedentary lifestyle and an improvement in quality of life, the modifiable risk factors for kidney diseases.
{"title":"Monitoring of the Renal Function in the Nursing Practice","authors":"Lim Wl, Duarte Ttp, Nava Lf, E. M. Mcs","doi":"10.26420/austinjnephrolhypertens.2023.1104","DOIUrl":"https://doi.org/10.26420/austinjnephrolhypertens.2023.1104","url":null,"abstract":"Objective: Verify the effects of intensified and usual clinical nursing monitoring on the quality of life and sedentary lifestyle of hypertensive and diabetic patients in primary care. Method: A quantitative and quasi-experimental study of time series. The sample this study consisted in 85 users allocated in control (n=45) and experimental (n=40) groups. The intervention was a nursing consultation with biochemical monitoring program. Results: With the monitoring, laboratory variables in experimental group were controlled, such as serum creatinine (0.82 – 0.79 mg/dL). The control group included 6 (26.09%) patients with renal dysfunction (p=0.001). Sedentary lifestyle was reduced in the experimental group (15.00% to 0.00%). The psychological domain of quality of life presented a better perception in the group without renal dysfunction, when compared to the users with renal dysfunction (80.8 ± 0.19 vs 51.8 ± 0.21, p=0.013). Conclusion: Results proved to be relevant for the Nursing assistance practice with reduction of sedentary lifestyle and an improvement in quality of life, the modifiable risk factors for kidney diseases.","PeriodicalId":91451,"journal":{"name":"Austin journal of nephrology and hypertension","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46876055","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 : 2022-10-16DOI: 10.26420/austinjnephrolhypertens.2021.1099
Bejoy J
Coronavirus Disease 2019 (COVID-19) is a worldwide spread pandemic that mostly affects the respiratory system. The viral agent of COVID-19 infection is the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which results from subclinical infection to multi-organ failure. According to a recent report patients hospitalized with COVID-19 are at high risk of Acute Kidney Injury (AKI). There is currently a discussion regarding how COVID-19 affects kidneys, with contradictory assertions about the method. The current article summarizes the most recent reports and studies on COVID-19 infection in the kidney.
{"title":"COVID-19 Infection in the Kidney: Information Thus Far","authors":"Bejoy J","doi":"10.26420/austinjnephrolhypertens.2021.1099","DOIUrl":"https://doi.org/10.26420/austinjnephrolhypertens.2021.1099","url":null,"abstract":"Coronavirus Disease 2019 (COVID-19) is a worldwide spread pandemic that mostly affects the respiratory system. The viral agent of COVID-19 infection is the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which results from subclinical infection to multi-organ failure. According to a recent report patients hospitalized with COVID-19 are at high risk of Acute Kidney Injury (AKI). There is currently a discussion regarding how COVID-19 affects kidneys, with contradictory assertions about the method. The current article summarizes the most recent reports and studies on COVID-19 infection in the kidney.","PeriodicalId":91451,"journal":{"name":"Austin journal of nephrology and hypertension","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44572170","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 : 2022-03-17DOI: 10.26420/austinjnephrolhypertens.2021.1103
Kena Wang, Yongc hen, Jiayun Xu
Objectives: Currently, immunosuppressants including cyclophosphamide and azathioprine are the main treatment options for anti-neutrophil associated vasculitis. However, since cyclophosphamide may cause serious adverse reactions, it is necessary to explore for a new drug, and rituximab is one option with less adverse reaction. There are a few studies on rituximab versus cyclophosphamide in the treatment of antineutrophil associated vasculitis. The meta-analysis is carried out to evaluate the efficacy of rituximab, compared with cyclophosphamide, as a remission induction therapy in AAV. Methods: Firstly we searched a Chinese database (CNKI, Wanfang) and English databases (Pubmed, Cochrane Library, Embase) according to inclusion criteria and exclusion criteria before October, 2021. Then Revman5.4 and Stata were used for data analysis which was then integrated by fixed effects or random effects. Results: After browsing the full texts, we finally included 7 eligible articles, involving 737 patients in total. With Revman5.4 software, we could draw the following conclusions: 6-month complete response rate (Chi²=0.46, df=1 P=0.50 I²=0%), 12-month complete response rate (Chi²=0.31 df=1 P=0.58 I²=0%), 18-month complete response rate (Chi²=0.18 df=1 P=0.67 I²=0%). Adverse event (Chi²=3.15 df=4 P=0.53 I²=0%), respectively for reached primary endpoint, failed primary endpoint in contrast. The result showed (Chi²=3.29 df=3 P=0.35 I²=9%, Chi²=1.72 df=2 P=0.42 I²=0%), 6-momth relapse, 12-momth relapse, 18-month relapse (Chi²=0.22 df=1 P=0.64 I²=0%, Chi²=0.04 df=2 P=0.98 I²=0%, Chi²=0.13 df=1 P=0.72 I²=0%), GPA 0f 6-month (Chi²=0.47 df=1 P=0.50 I²=0%), MPA of 6-month (Chi²=1.52 df=1 P=0.22 I²=34%). The above data are statistically significant. Conclusion: Based on the above data, we can conclude that compared with cyclophosphamide, rituximab can play a certain role in the treatment of ANCA disease, improve the complete response rate, reduce the rate of adverse reactions and recurrence, and is expected to replace cyclophosphamide as a first-line drug in clinical practice.
{"title":"Comparison between Rituximab and Cyclophosphamide in Treatment of ANCA-Associated Vasculitis on Remission Induction: A Meta-Analysis","authors":"Kena Wang, Yongc hen, Jiayun Xu","doi":"10.26420/austinjnephrolhypertens.2021.1103","DOIUrl":"https://doi.org/10.26420/austinjnephrolhypertens.2021.1103","url":null,"abstract":"Objectives: Currently, immunosuppressants including cyclophosphamide and azathioprine are the main treatment options for anti-neutrophil associated vasculitis. However, since cyclophosphamide may cause serious adverse reactions, it is necessary to explore for a new drug, and rituximab is one option with less adverse reaction. There are a few studies on rituximab versus cyclophosphamide in the treatment of antineutrophil associated vasculitis. The meta-analysis is carried out to evaluate the efficacy of rituximab, compared with cyclophosphamide, as a remission induction therapy in AAV. Methods: Firstly we searched a Chinese database (CNKI, Wanfang) and English databases (Pubmed, Cochrane Library, Embase) according to inclusion criteria and exclusion criteria before October, 2021. Then Revman5.4 and Stata were used for data analysis which was then integrated by fixed effects or random effects. Results: After browsing the full texts, we finally included 7 eligible articles, involving 737 patients in total. With Revman5.4 software, we could draw the following conclusions: 6-month complete response rate (Chi²=0.46, df=1 P=0.50 I²=0%), 12-month complete response rate (Chi²=0.31 df=1 P=0.58 I²=0%), 18-month complete response rate (Chi²=0.18 df=1 P=0.67 I²=0%). Adverse event (Chi²=3.15 df=4 P=0.53 I²=0%), respectively for reached primary endpoint, failed primary endpoint in contrast. The result showed (Chi²=3.29 df=3 P=0.35 I²=9%, Chi²=1.72 df=2 P=0.42 I²=0%), 6-momth relapse, 12-momth relapse, 18-month relapse (Chi²=0.22 df=1 P=0.64 I²=0%, Chi²=0.04 df=2 P=0.98 I²=0%, Chi²=0.13 df=1 P=0.72 I²=0%), GPA 0f 6-month (Chi²=0.47 df=1 P=0.50 I²=0%), MPA of 6-month (Chi²=1.52 df=1 P=0.22 I²=34%). The above data are statistically significant. Conclusion: Based on the above data, we can conclude that compared with cyclophosphamide, rituximab can play a certain role in the treatment of ANCA disease, improve the complete response rate, reduce the rate of adverse reactions and recurrence, and is expected to replace cyclophosphamide as a first-line drug in clinical practice.","PeriodicalId":91451,"journal":{"name":"Austin journal of nephrology and hypertension","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43503779","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}
S. Memon, A. Alam, B. Salman, J. Chughtai, S. Imtiaz
Purpose: Hyponatremia is frequently observed electrolytes derangement in both medical and surgical specialties with a variety of underlying illnesses. The rapidity of sodium derangement and symptoms at the time of presentation help to decide its management plan. Many times, treating primary disease specifically along with just conservative steps for hyponatremia i.e., plain water restriction, adding salt, or infusion isotonic saline help achieve desirable results. Patients and methods: This observational study was conducted at the Indus Hospital and Health Network (IHHN) from July 2017 to April 2020 with the approval of Interactive and Research Development (IRB-IRD). All those (age >14 years) of either gender, admitted under various specialties with hyponatremia (serum sodium<135 meq/L) were enrolled after taking consent. Their history, demographics, volume status, and investigation were done and hyponatremia was categorized as mild (130 to 134 meq/L), moderate (125 to 129 meq/L), and severe (<125 meq/L). The outcome was noted on the pre-formed questionnaire as Sodium improve/ unimproved, discharged, expired. Results: Out of 262 patients with a male to female ratio of 0.8/1 (123/139), the most prevalent comorbid was hypertension 177 (67.6%), followed by CKD 171 (65.3%) and DM 142 (54.2%). The majority 102 (38.9%) had a moderate degree of hyponatremia while hypovolemia was the predominant volume status observed in 131 (50%) patients. Symptomatic hyponatremia was present in 38 (14.5%) patients. The majority of patients recovered and discharged 234 (89.3%), of which only 2 patients required hypertonic saline.
{"title":"Hyponatremia Under Various Specialties","authors":"S. Memon, A. Alam, B. Salman, J. Chughtai, S. Imtiaz","doi":"10.33582/2637-9619/1016","DOIUrl":"https://doi.org/10.33582/2637-9619/1016","url":null,"abstract":"Purpose: Hyponatremia is frequently observed electrolytes derangement in both medical and surgical specialties with a variety of underlying illnesses. The rapidity of sodium derangement and symptoms at the time of presentation help to decide its management plan. Many times, treating primary disease specifically along with just conservative steps for hyponatremia i.e., plain water restriction, adding salt, or infusion isotonic saline help achieve desirable results. Patients and methods: This observational study was conducted at the Indus Hospital and Health Network (IHHN) from July 2017 to April 2020 with the approval of Interactive and Research Development (IRB-IRD). All those (age >14 years) of either gender, admitted under various specialties with hyponatremia (serum sodium<135 meq/L) were enrolled after taking consent. Their history, demographics, volume status, and investigation were done and hyponatremia was categorized as mild (130 to 134 meq/L), moderate (125 to 129 meq/L), and severe (<125 meq/L). The outcome was noted on the pre-formed questionnaire as Sodium improve/ unimproved, discharged, expired. Results: Out of 262 patients with a male to female ratio of 0.8/1 (123/139), the most prevalent comorbid was hypertension 177 (67.6%), followed by CKD 171 (65.3%) and DM 142 (54.2%). The majority 102 (38.9%) had a moderate degree of hyponatremia while hypovolemia was the predominant volume status observed in 131 (50%) patients. Symptomatic hyponatremia was present in 38 (14.5%) patients. The majority of patients recovered and discharged 234 (89.3%), of which only 2 patients required hypertonic saline.","PeriodicalId":91451,"journal":{"name":"Austin journal of nephrology and hypertension","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75674593","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 : 2022-01-28DOI: 10.26420/austinjnephrolhypertens.2022.1102
Oliveira J, Freitas J, S. I, S. S, Carvalho Mj, R. A., Cabrita A
Introduction: Posterior reversible encephalopathy syndrome (PRES) represents a neurological disorder with varied clinical presentation and typical imaging findings. End-stage-renal-disease patients have a combination of riskfactors for PRES: hypertension, volume-overload, erythropoietin stimulating agents, immunosuppressants, hyponatremia, uremia. Methods: We explored the presentation and outcome of PRES in a chronic peritoneal-dialysis (PD) population over a 2-year period. We also reviewed the literature on PRES in PD. Result: 3 patients had PRES over a 2-year period. They were young, had uncontrolled hypertension and most presented shortly after PD-induction. Fluid/salt non-compliance, faster decline of urine-output after graft-failure, maintenance immunosuppression/ESA was possible triggers. Conclusion: PRES is a serious complication associated with a higher risk for dialytic modality transition since subclinical hypervolemia is a prevalent and probable risk factor. The complication is hardly predictable, with inconsistent correlation of clinical presentation, blood-pressure and weight-gain profiles after PD-induction.
{"title":"A Critical Review of Posterior Reversible Encephalopathy Syndrome Cases in a Peritoneal Dialysis Population: Case Series and Review of Literature","authors":"Oliveira J, Freitas J, S. I, S. S, Carvalho Mj, R. A., Cabrita A","doi":"10.26420/austinjnephrolhypertens.2022.1102","DOIUrl":"https://doi.org/10.26420/austinjnephrolhypertens.2022.1102","url":null,"abstract":"Introduction: Posterior reversible encephalopathy syndrome (PRES) represents a neurological disorder with varied clinical presentation and typical imaging findings. End-stage-renal-disease patients have a combination of riskfactors for PRES: hypertension, volume-overload, erythropoietin stimulating agents, immunosuppressants, hyponatremia, uremia. Methods: We explored the presentation and outcome of PRES in a chronic peritoneal-dialysis (PD) population over a 2-year period. We also reviewed the literature on PRES in PD. Result: 3 patients had PRES over a 2-year period. They were young, had uncontrolled hypertension and most presented shortly after PD-induction. Fluid/salt non-compliance, faster decline of urine-output after graft-failure, maintenance immunosuppression/ESA was possible triggers. Conclusion: PRES is a serious complication associated with a higher risk for dialytic modality transition since subclinical hypervolemia is a prevalent and probable risk factor. The complication is hardly predictable, with inconsistent correlation of clinical presentation, blood-pressure and weight-gain profiles after PD-induction.","PeriodicalId":91451,"journal":{"name":"Austin journal of nephrology and hypertension","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47051783","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 : 2021-11-10DOI: 10.26420/austinjnephrolhypertens.2021.1100
Bhuwania P
Background: Moderate-risk for Cytomegalovirus (CMV) infection includes patients with donor positive/recipient positive (D+/R+) or donor negative/ recipient positive antibody status (D-/R+). Guidelines recommend high-dose daily Valganciclovir (VGCV) as prophylaxis, which may be due to the paucity of data on the efficacy of every-other-day VGCV. Methods: Our experience of using every-other-day VGCV as a prophylactic strategy in moderate risk Kidney Transplant Recipients (KTR) has been described. We retrospectively reviewed 86 moderate-risk KTR in our institution between 2018 and 2020. CMV infection at 6 months post-transplant was the primary endpoint. Graft survival, biopsy-proven rejection, opportunistic infections, Haematological adverse events, and mortality were also evaluated. Results: CMV infection occurrence at 6 months was zero in our cohort. Incidence of leukopenia was 13%, BPAR-31%, OI-33%, and mortality being 3.5%. Conclusion: Every-Other-Day VGCV dosing can be an effective alternative in moderate risk KTR for CMV prevention.
{"title":"Every-Other-Day Valganciclovir Prophylaxis for Cytomegalovirus Prevention in Kidney Transplant Recipients: A Single-Center Experience","authors":"Bhuwania P","doi":"10.26420/austinjnephrolhypertens.2021.1100","DOIUrl":"https://doi.org/10.26420/austinjnephrolhypertens.2021.1100","url":null,"abstract":"Background: Moderate-risk for Cytomegalovirus (CMV) infection includes patients with donor positive/recipient positive (D+/R+) or donor negative/ recipient positive antibody status (D-/R+). Guidelines recommend high-dose daily Valganciclovir (VGCV) as prophylaxis, which may be due to the paucity of data on the efficacy of every-other-day VGCV. Methods: Our experience of using every-other-day VGCV as a prophylactic strategy in moderate risk Kidney Transplant Recipients (KTR) has been described. We retrospectively reviewed 86 moderate-risk KTR in our institution between 2018 and 2020. CMV infection at 6 months post-transplant was the primary endpoint. Graft survival, biopsy-proven rejection, opportunistic infections, Haematological adverse events, and mortality were also evaluated. Results: CMV infection occurrence at 6 months was zero in our cohort. Incidence of leukopenia was 13%, BPAR-31%, OI-33%, and mortality being 3.5%. Conclusion: Every-Other-Day VGCV dosing can be an effective alternative in moderate risk KTR for CMV prevention.","PeriodicalId":91451,"journal":{"name":"Austin journal of nephrology and hypertension","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42066392","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 : 2021-10-15DOI: 10.26420/austinjnephrolhypertens.2021.1098
S. M., D. M.
Introduction: Non-pharmacological strategies such as lowering sodium intake aim to protect renal function and delay the initiation of renal replacement therapy. It might also be a cost-effective method to improve Chronic Kidney Disease (CKD) prognosis. We decided to perform a meta-analysis of Randomized Controlled Trials (RCTs) to evaluate the effects of low versus high sodium intake in adults with CKD. Methodology: We searched the online databases – PUBMED, Cochrane Kidney and Transplant Specialized Register, Cochrane Library and Google Scholar to 31st December 2020 for RCTs to be included in the study. Meta- Analysis was performed for the intervention groups for each arm against the control. Inverse variance methods were applied for analysis using random effects models due to the high heterogeneity among the studies. Results: Our search strategy yielded seven studies from six countries with 465 participants. The overall effect on restricted sodium intake favored reduction in systolic blood pressure with an overall mean difference of -6.14(95% CI: -9.52, -2.76) and reduction in diastolic blood pressure with a mean difference of -3.08 (95% CI: -4.62, -1.55). There was lowering of estimated Glomerular Filtration Rate (eGFR), however the same was not statistically significant. Conclusion: The study found that restricted salt intake could significantly reduce systolic and diastolic BP. Further, multi-center RCTs for longer durations across different stages of CKD could effectively assess the effects of restricted sodium intake on vital parameters. Such study designs could also help clinicians identify the optimal intake of dietary sodium to achieve better renal and cardio vascular outcomes.
{"title":"Dietary Sodium Restriction in the Management of Chronic Kidney Disease: A Meta-Analysis of RCTs","authors":"S. M., D. M.","doi":"10.26420/austinjnephrolhypertens.2021.1098","DOIUrl":"https://doi.org/10.26420/austinjnephrolhypertens.2021.1098","url":null,"abstract":"Introduction: Non-pharmacological strategies such as lowering sodium intake aim to protect renal function and delay the initiation of renal replacement therapy. It might also be a cost-effective method to improve Chronic Kidney Disease (CKD) prognosis. We decided to perform a meta-analysis of Randomized Controlled Trials (RCTs) to evaluate the effects of low versus high sodium intake in adults with CKD. Methodology: We searched the online databases – PUBMED, Cochrane Kidney and Transplant Specialized Register, Cochrane Library and Google Scholar to 31st December 2020 for RCTs to be included in the study. Meta- Analysis was performed for the intervention groups for each arm against the control. Inverse variance methods were applied for analysis using random effects models due to the high heterogeneity among the studies. Results: Our search strategy yielded seven studies from six countries with 465 participants. The overall effect on restricted sodium intake favored reduction in systolic blood pressure with an overall mean difference of -6.14(95% CI: -9.52, -2.76) and reduction in diastolic blood pressure with a mean difference of -3.08 (95% CI: -4.62, -1.55). There was lowering of estimated Glomerular Filtration Rate (eGFR), however the same was not statistically significant. Conclusion: The study found that restricted salt intake could significantly reduce systolic and diastolic BP. Further, multi-center RCTs for longer durations across different stages of CKD could effectively assess the effects of restricted sodium intake on vital parameters. Such study designs could also help clinicians identify the optimal intake of dietary sodium to achieve better renal and cardio vascular outcomes.","PeriodicalId":91451,"journal":{"name":"Austin journal of nephrology and hypertension","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45456927","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 : 2021-10-14DOI: 10.26420/austinjnephrolhypertens.2021.1097
Alsultan Mh, H. Q
Clostridium difficile infection was identified as the major cause of antibioticassociated diarrhea and cause wide manifestations include asymptomatic, fulminant disease and unusual manifestations such as protein-losing enteropathy. The incidence and severity of healthcare-associated clostridium difficile have been dramatically increased. A 25-years old male with end-stage renal disease who on hemodialysis complained of nonbloody watery diarrhea and abdominal pain for a month. Also, he had a hospital admission due to secondary peritonitis with negative investigations and was treated with antibiotics with no improvement. Abdominal CT scan revealed a moderate amount of ascites with wall thickening of transverse colon and culture of ascites was negative. A stool examination was positive for clostridium difficile toxins (A+B) and cured by 21 days of oral vancomycin. A literature review for ascites- induced by clostridium difficile yielded only one patient with end-stage renal disease on hemodialysis. First-line clinicians may not be familiar with such a rare manifestation and may not initially consider it when making differential diagnosis related to secondary peritonitis. Clostridium difficile should be suspected in all cases of diarrhea in patients with chronic kidney disease and should be considered in the presence of ascites in the context of diarrhea with no obvious source.
{"title":"A Rare Culture-Negative Ascites Induced by Clostridium Difficile in a Patient with End-Stage Renal Disease: A Case Report and Literature Review","authors":"Alsultan Mh, H. Q","doi":"10.26420/austinjnephrolhypertens.2021.1097","DOIUrl":"https://doi.org/10.26420/austinjnephrolhypertens.2021.1097","url":null,"abstract":"Clostridium difficile infection was identified as the major cause of antibioticassociated diarrhea and cause wide manifestations include asymptomatic, fulminant disease and unusual manifestations such as protein-losing enteropathy. The incidence and severity of healthcare-associated clostridium difficile have been dramatically increased. A 25-years old male with end-stage renal disease who on hemodialysis complained of nonbloody watery diarrhea and abdominal pain for a month. Also, he had a hospital admission due to secondary peritonitis with negative investigations and was treated with antibiotics with no improvement. Abdominal CT scan revealed a moderate amount of ascites with wall thickening of transverse colon and culture of ascites was negative. A stool examination was positive for clostridium difficile toxins (A+B) and cured by 21 days of oral vancomycin. A literature review for ascites- induced by clostridium difficile yielded only one patient with end-stage renal disease on hemodialysis. First-line clinicians may not be familiar with such a rare manifestation and may not initially consider it when making differential diagnosis related to secondary peritonitis. Clostridium difficile should be suspected in all cases of diarrhea in patients with chronic kidney disease and should be considered in the presence of ascites in the context of diarrhea with no obvious source.","PeriodicalId":91451,"journal":{"name":"Austin journal of nephrology and hypertension","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43623155","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 : 2021-10-09DOI: 10.26420/austinjnephrolhypertens.2021.1096
Bramania Pk, Ruggajo Pj, Furia Ff
Background: Erythropoietin-resistant anaemia in hemodialysis patients is accompanied by poor outcomes. Malnutrition and inflammation impair effective erythropoiesis through various mechanisms and may cause erythropoietin resistance. In this study, we aimed to determine the effect of malnutrition inflammatory complex on erythropoietin resistance among patients on maintenance hemodialysis at Muhimbili National Hospital in Dar es Salaam, Tanzania. Materials and Methods: This was a hospital-based retrospective cross-sectional study involving 85 patients on maintenance hemodialysis. Participants’ information was collected and recorded in data collection tools; this information included clinical and physical information (body weight and height) and laboratory tests (complete blood count, serum albumin, C-reactive protein, transferrin, total iron, ferritin, and urea). Bodyweight and height were measured and body mass index calculated. Erythropoietin Resistance Index (ERI) was obtained as the weight-adjusted average weekly erythropoietin dose divided by hemoglobin level, while Malnutrition Inflammation Score (MIS) was used to determine Malnutrition Inflammation Complex Syndrome (MICS). Results: Eighty-five participants were recruited for this study, of which 76.5% were males and the mean age was 54.1 ± 13.2 years. MICS was noted in 50.6% participants. The overall mean weight-adjusted ERI of the study population was 20.6 ± 7.7 units/kg per g/dl. Patients with inflammation, MICS, and on long-term hemodialysis had significantly higher mean ERI. On multivariate analysis, ERI significantly correlated with MIS (p <0.01) in a dose-dependent manner. Conclusion: In hemodialysis patients, anaemia resistant to Erythropoietin therapy is linked to malnutrition inflammation complex syndrome. MICS needs to be appropriately treated to achieve target hemoglobin levels.
{"title":"Erythropoietin Resistant Anaemia among Haemodialysis Patients with Malnutrition Inflammation Complex Syndrome in Dar es Salaam, Tanzania","authors":"Bramania Pk, Ruggajo Pj, Furia Ff","doi":"10.26420/austinjnephrolhypertens.2021.1096","DOIUrl":"https://doi.org/10.26420/austinjnephrolhypertens.2021.1096","url":null,"abstract":"Background: Erythropoietin-resistant anaemia in hemodialysis patients is accompanied by poor outcomes. Malnutrition and inflammation impair effective erythropoiesis through various mechanisms and may cause erythropoietin resistance. In this study, we aimed to determine the effect of malnutrition inflammatory complex on erythropoietin resistance among patients on maintenance hemodialysis at Muhimbili National Hospital in Dar es Salaam, Tanzania. Materials and Methods: This was a hospital-based retrospective cross-sectional study involving 85 patients on maintenance hemodialysis. Participants’ information was collected and recorded in data collection tools; this information included clinical and physical information (body weight and height) and laboratory tests (complete blood count, serum albumin, C-reactive protein, transferrin, total iron, ferritin, and urea). Bodyweight and height were measured and body mass index calculated. Erythropoietin Resistance Index (ERI) was obtained as the weight-adjusted average weekly erythropoietin dose divided by hemoglobin level, while Malnutrition Inflammation Score (MIS) was used to determine Malnutrition Inflammation Complex Syndrome (MICS). Results: Eighty-five participants were recruited for this study, of which 76.5% were males and the mean age was 54.1 ± 13.2 years. MICS was noted in 50.6% participants. The overall mean weight-adjusted ERI of the study population was 20.6 ± 7.7 units/kg per g/dl. Patients with inflammation, MICS, and on long-term hemodialysis had significantly higher mean ERI. On multivariate analysis, ERI significantly correlated with MIS (p <0.01) in a dose-dependent manner. Conclusion: In hemodialysis patients, anaemia resistant to Erythropoietin therapy is linked to malnutrition inflammation complex syndrome. MICS needs to be appropriately treated to achieve target hemoglobin levels.","PeriodicalId":91451,"journal":{"name":"Austin journal of nephrology and hypertension","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46268862","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 : 2021-07-22DOI: 10.26420/austinjnephrolhypertens.2021.1095
Helman Sr, Stewart Pm, Siddiqui T, Fink Jc, W. S
Objective: The impact of Nonsteroidal Anti-Inflammatory Drugs (NSAID) and iodine-based contrast exposures on developing Chronic Kidney Disease (CKD) is controversial. We examined the association of these exposures with the development of CKD in a Veteran population. Methods: A retrospective case-control study of 154,448 veterans from the Veterans Affairs (VA) Corporate Data Warehouse (CDW) database between 2005 and 2014 was conducted to assess the association between incident stage 3 CKD with Acute Kidney Injury (AKI), NSAID use, iodine-based contrast exposures, and comorbid conditions. Stepwise logistic regression was used to determine multivariable adjusted Odds Ratios (OR). Results: The mean age was 59 (SD±13), and the median eGFR was 84 (IQR: 73, 96). AKI was associated with increased odds of CKD (inpatient: OR=3.76, 95% CI: 3.44, 4.11; outpatient: OR=4.73, 95% CI: 4.09, 5.46) and demonstrated escalated odds with >1 episode (inpatient: OR=5.72, 95% CI: 4.71, 6.95; outpatient: OR=8.36, 95% CI: 6.32, 11.06). Months of NSAID prescriptions was associated with CKD, with ORs at >0-6 months, >6-12 months, and >12 months of 1.27 (95% CI: 1.23, 1.32), 1.54 (95% CI: 1.46, 1.63), and 1.69 (95% CI: 1.62, 1.77) respectively. Iodine-based contrast exposure was associated with increased odds of CKD, with ORs for 1-2 Computed Tomography (CT) scans, ≥3CT scans, and left heart catheterization of 1.29 (95% CI: 1.24, 1.35), 1.29 (95% CI: 1.20, 1.28), and 1.38 (95% CI: 1.17, 1.63) respectively. Conclusion: AKI events, NSAID use, and iodine-based contrast exposures are associated with increased odds for developing stage 3 CKD in veterans.
{"title":"Association of Kidney-Related Safety Events with Incident Chronic Kidney Disease in Veterans","authors":"Helman Sr, Stewart Pm, Siddiqui T, Fink Jc, W. S","doi":"10.26420/austinjnephrolhypertens.2021.1095","DOIUrl":"https://doi.org/10.26420/austinjnephrolhypertens.2021.1095","url":null,"abstract":"Objective: The impact of Nonsteroidal Anti-Inflammatory Drugs (NSAID) and iodine-based contrast exposures on developing Chronic Kidney Disease (CKD) is controversial. We examined the association of these exposures with the development of CKD in a Veteran population. Methods: A retrospective case-control study of 154,448 veterans from the Veterans Affairs (VA) Corporate Data Warehouse (CDW) database between 2005 and 2014 was conducted to assess the association between incident stage 3 CKD with Acute Kidney Injury (AKI), NSAID use, iodine-based contrast exposures, and comorbid conditions. Stepwise logistic regression was used to determine multivariable adjusted Odds Ratios (OR). Results: The mean age was 59 (SD±13), and the median eGFR was 84 (IQR: 73, 96). AKI was associated with increased odds of CKD (inpatient: OR=3.76, 95% CI: 3.44, 4.11; outpatient: OR=4.73, 95% CI: 4.09, 5.46) and demonstrated escalated odds with >1 episode (inpatient: OR=5.72, 95% CI: 4.71, 6.95; outpatient: OR=8.36, 95% CI: 6.32, 11.06). Months of NSAID prescriptions was associated with CKD, with ORs at >0-6 months, >6-12 months, and >12 months of 1.27 (95% CI: 1.23, 1.32), 1.54 (95% CI: 1.46, 1.63), and 1.69 (95% CI: 1.62, 1.77) respectively. Iodine-based contrast exposure was associated with increased odds of CKD, with ORs for 1-2 Computed Tomography (CT) scans, ≥3CT scans, and left heart catheterization of 1.29 (95% CI: 1.24, 1.35), 1.29 (95% CI: 1.20, 1.28), and 1.38 (95% CI: 1.17, 1.63) respectively. Conclusion: AKI events, NSAID use, and iodine-based contrast exposures are associated with increased odds for developing stage 3 CKD in veterans.","PeriodicalId":91451,"journal":{"name":"Austin journal of nephrology and hypertension","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42409177","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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