Nephrology Commons^™

Renal Disease Rehabilitation And Delaying Dialysis, Spencer Brown, Natalie Sterner

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Greenwood SA, Koufaki P, Mercer TH, et al. Effect of exercise training on estimated GFR, vascular health, and cardiorespiratory fitness in patients with CKD: a pilot randomized controlled trial. Am J Kidney Dis. 2015;65(3):425-434. https://doi.org/10.1053/j.ajkd.2014.07.015

for a patient with non-dialysis CKD interested in slowing the progression toward necessary dialysis.

Use Of Point Of Care Ultrasound In The Pre-Op Evaluation Of Dialysis Patients Needing Creation Of Permanent Arteriovenous Access – Preliminary Study, Urvashi Mathur, Sotero Peralta

Research Colloquium

Background: Non-invasive ultrasound evaluation is part of the preoperative evaluation of patients needing creation of arteriovenous access. This study requires patients to return for an additional visit for imaging or visit an outpatient imaging facility. These visits produce delays in surgery and increase costs in healthcare. Point of care ultrasound examination at the same time of initial physician visit, allows to decrease cost, improvement of anatomical planning, and decrease timing of surgery.

Methods: We reviewed the UTRGV Vascular Surgery Database from January to December 2020, for patients who has elective outpatient arteriovenous access creation, in which has pre-operative evaluation with …

Proton-Pump Inhibitors Related Acute Interstitial Nephritis. A Case Report, Mery B. Bartl, Reham Majzoub

Research Colloquium

Background: Acute Interstitial nephritis is a common and reversible cause of Acute Kidney Injury, accounting for 15-27% of renal biopsies performed because of this condition. Its incidence has been increasing worldwide. By and large, drug-induced AIN is currently the most common etiology, with antimicrobials and nonsteroidal anti-inflammatory drugs being the most frequent offending agents. The hallmark pathologic features are interstitial edema, interstitial inflammation, and tubulitis with a predominance of CD4+ T lymphocytes and mononuclear cells, with variable numbers of eosinophils. Patients with AIN typically present with nonspecific symptoms of acute renal failure, including oliguria, malaise, anorexia, nausea, and vomiting and …

Penile Calciphylaxis In An End Stage Renal Disease Patient., Juan Enrique Garcia Lopez, Alain Velazquez Blanco, Aileen Aguilar, Sareena Siyas, Daniel Ibarias Paz, Mays Abdulazeez, Jesus Garza-Tamez, Desmond Adamu

Research Colloquium

Background: Penile Calciphylaxis occurs in about 1–4% of hemodialysis patients worldwide. Associated mortality rates are very high, and hyperparathyroidism is the second most frequently associated disorder. Addressing the resulting metabolic imbalance, and surgical intervention guided by findings of radiological studies may improve quality of life. The pathogenesis is thought to be mediated by vascular smooth muscle cells which differentiate into osteoblast-like cells. Decrease in vascular calcification inhibitory proteins fetuin-A and matrix Gla is found in patients on dialysis causing systemic medial calcification of arterioles, leading to epidermal ischemia, tissue infarction, and ulceration.

Case presentation: 47-year-old male with history of coronary …

The Impact Of Pediatric Ckd On Educational And Employment Outcomes., Lyndsay A. Harshman, Ryan C. Ward, Matthew B. Matheson, Anne Dawson, Amy J. Kogon, Marc B. Lande, Stephen J. Molitor, Rebecca J. Johnson, Camille Wilson, Bradley A. Warady, Susan L. Furth, Stephen R. Hooper

Manuscripts, Articles, Book Chapters and Other Papers

KEY POINTS: This study evaluates educational and employment outcomes in patients with pediatric kidney disease and assesses predictors of educational attainment and employment in young adulthood. Despite high rates of high school graduation, nearly 20% of patients with CKD are unemployed or receiving disability at long-term follow-up.

BACKGROUND: Pediatric patients with CKD are at risk for neurocognitive deficits and academic underachievement. This population may be at risk for lower educational attainment and higher rates of unemployment; however, published data have focused on patients with advanced CKD and exist in isolation from assessment of neurocognition and kidney function.

METHODS: Data from …

Profilaksis Vs. Terapi Preemtif Penyakit Cytomegalovirus (Cmv) Pada Pasien Transplantasi Ginjal Risiko Tinggi: Suatu Laporan Kasus Berbasis Bukti, Ariani Intan Wardhani, Rahajeng N. Tunjungputri, Erpryta Nurdia Tetrasiwi, Maruhum Bonar Marbun

Jurnal Penyakit Dalam Indonesia

Kidney transplant recipients require the use of immunosuppressive agents to prevent multiple organ rejection. Administration of immunosuppressive agents triggers an increased risk of impaired immunity and microbial infections, one of which is cytomegalovirus (CMV). Prevention of cytomegalovirus infection can be given as a prophylaxis or preemptive therapy. However, the efficacy of choosing prophylaxis or preemptive therapy is still under debate, thus we conducted this study to identify current approach in preventing CMV disease in clinical practice. A literature search was carried out using the PubMed, Cochrane Library, Embase and Scopus databases with the keywords “high risk …

Prevalência Do Genótipo De Risco G1/G2 Do Gene Da Apolipoproteína L1 (Apol1) E Associação Com Doença Renal Crônica Não Diabética Em Autodeclarados Negros No Sul Do Brasil, Celia Mariana Souza, Maicon Douglas Torely, Mauro Ribeiro Soares Junior, Wiliam Cardoso Silva, Bibiana Sampaio Oliveira Fam, Giovanna Giudicelli, Thayne Kwalski, Marilea Feira Furtado, Renan Barbosa Lemes, Lygia Veiga Pereira, Tábita Hunemeier, Francisco Verissimo Veronese, Fernanda Sales Luiz Vianna

AMNET XX Conferencia Internacional

Introdução: A doença renal crônica (DRC) possui uma prevalência de 10% entre os brasileiros. A presença de dois alelos de risco chamados G1 e G2 do gene da Apo lipoproteína L1 ( APOL1 ), mais frequente em indivíduos associados de ascendência africana e foram à DRC.

Objetivos: Determinar a prevalência dos alelos e genótipo de APOL1 em pacientes portadores de DRC em comparação com indivíduos afrodescendentes saudáveis.

Métodos: Estudo caso controle, realizado nos ambulatórios de Nefrologia do hospital de Clínicas de Porto Alegre, na Santa Casa de Misericórdia de Porto Alegre; Clínicas de hemodiálise Grande Porto Alegre Litoral e Cidades …

Rede Neural Para A Predição De Óbito Utilizando Biomarcadores De Pacientes Em Hemodiálise No Sistema Único De Saúde., Isadora Badalotti-Teloken

AMNET XX Conferencia Internacional

No abstract provided.

Indicadores De Qualidade Da Anticoagulação Regional Com Citrato De Sódio Em Hemodiálise Prolongada: Um Estudo De Coorte, Amanda Corrêa Dos Santos

AMNET XX Conferencia Internacional

Objetivo: Analisar Indicadores de Qualidade (QIs) de segurança e efetividade na Hemodiálise (HD) prolongada com Anticoagulação Regional com Citrato de Sódio 4% (ARCS) em sistema híbrido Genius® em pacientes de unidades de terapia intensiva (UTI) com injúria renal aguda (IRA).

Método: Coorte retrospectiva realizada entre 2019 e 2021 em uma UTI do Hospital São Lucas da PUCRS. Foram incluídos maiores de 18 anos internados em UTI com IRA e em HD prolongada com ARCS em sistema híbrido Genius®. Dados foram coletados manualmente em prontuário eletrônico e nas folhas de fluxo da diálise. Avaliou-se indicadores de segurança (completude …

Programa De Atividade Física Via Telemonitoramento E Capacidade De Exercício Em Pacientes Pediátricos Submetidos A Transplante Renal: Dados Preliminares, Ana Clara Sobotyk Santos

AMNET XX Conferencia Internacional

Objetivo: avaliar os efeitos de um programa de atividade física via telemonitoramento na capacidade funcional (Shuttle Walk Test – SWT) em pacientes pediátricos após transplante (Tx) renal.

Método: ensaio clínico randomizado em crianças acompanhadas ambulatorialmente em hospital referência no Rio Grande do Sul. O treinamento foi realizado via telemonitoramento, 2 vezes por semana durante 6 semanas. Os pacientes foram randomizados (via software) em GI - treinamento com faixas elásticas; e GC - orientações e exercícios ventilatórios. O pesquisador que realiza as avaliações está cegado.

Resultados: amostra preliminar de 21 pacientes (9 no GI e 12 no GC). A idade média …

About Dying And Death: Thanatology's Place In Medical Curriculum, Jill Dombroski

Electronic Thesis and Dissertation Repository

This study explored how healthcare providers engage in advance care planning and end-of-life care conversations. The research explored what shapes their understanding and the extent to which concepts from thanatology they intuitively bring in, explicitly bring in, and maybe fail to recognize. To achieve this, constructivist grounded theory (CGT) methodology guided the design, data collection, analysis, and interpretation of the findings, which allowed for iteration across interviews and analysis with existing theories and data in the literature. The CGT design encouraged further engagement with the literature in an ongoing iterative fashion as well as with the analysis of the data. …

Fluoroscopic Guided Peritoneal Dialysis Catheter Placement: An Analysis Of Pelvic Catheter Positioning And Early Catheter Flow Dysfunction, David Clark

Electronic Thesis and Dissertation Repository

Fluoroscopic peritoneal dialysis catheter (FPDC) positioning has not been thoroughly evaluated. Using a retrospective cohort of adult patients who underwent FPDC insertion in London, Ontario (Feb 1, 2010 - Aug 1, 2017); we retrieved procedural radiographs measuring the level of intraabdominal radiocontrast to pubic symphysis (IRPS), and catheter tip to pubic symphysis (CTPS). The median (Q1-Q3) distance (millimeters) of IRPS was larger in females [35(25-44)] than males [28(19-37); P=0.001]; but this distance was not associated with variables: Age (years), BMI (Kg/m²), Race, PKD, abdominopelvic surgeries, in correlation/regression analyses. CTPS distance increased with BMI [(β; 95% Confidence Interval …

The Effectiveness Of Tirzepatide (Gip/Glp-1 Receptor Co-Agonist) Vs Glp-1 Receptor Agonists On Lowering A1c In Adults With Type 2 Diabetes Mellitus, Madison Laplante

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Introduction

In the United States, 34.2 million people are currently diagnosed with diabetes mellitus, which accounts for 10.5% of the total population.¹ Type 2 diabetes mellitus (T2DM) holds 94.2% of all diabetes diagnoses. The American Association of Diabetes estimates approximately $327 billion annually and is broken up as follows:¹

Prevention Of Intradialytic Hypotension In Hemodialysis Patients: Current Challenges And Future Prospects, Seyed Mehrdad Hamrahian, Salem Vilayet, Johann Herberth, Tibor Fülöp

Division of Nephrology Faculty Papers

Intradialytic hypotension, defined as rapid decrease in systolic blood pressure of greater than or equal to 20 mmHg or in mean arterial pressure of greater than or equal to 10 mmHg that results in end-organ ischemia and requires countermeasures such as ultrafiltration reduction or saline infusion to increase blood pressure to improve patient’s symptoms, is a known complication of hemodialysis and is associated with several potential adverse outcomes. Its pathogenesis is complex and involves both patient-related factors such as age and comorbidities, as well as factors related to the dialysis prescription itself. Key factors include the need for volume removal …

Associations Of Biomarkers Of Kidney Tubule Health, Injury, And Inflammation With Left Ventricular Hypertrophy In Children With Ckd., Kuan Jiang, Jason H. Greenberg, Alison Abraham, Yunwen Xu, Jeffrey R. Schelling, Harold I. Feldman, Sarah J. Schrauben, Sushrut S. Waikar, Michael G. Shlipak, Nicholas Wettersten, Steven G. Coca, Ramachandran S. Vasan, Orlando M. Gutierrez, Joachim H. Ix, Bradley A. Warady, Paul L. Kimmel, Joseph V. Bonventre, Chirag R. Parikh, Mark M. Mitsnefes, Michelle R. Denburg, Susan Furth, Ckd Biomarkers Consortium

Manuscripts, Articles, Book Chapters and Other Papers

KEY POINTS:

• Higher plasma and urine kidney injury molecule-1, urine monocyte chemoattractant protein-1, and lower urine alpha-1-microglobulin were associated with left ventricular hypertrophy, even after adjustment for confounders.
• Biomarkers of tubular injury, dysfunction, and inflammation may indicate the severity of kidney pathology and are associated with left ventricular hypertrophy.

BACKGROUND: Left ventricular hypertrophy (LVH) is common in children with CKD and is associated with an increased risk of cardiovascular disease and mortality. We have shown that several plasma and urine biomarkers are associated with increased risk of CKD progression. As CKD is associated with LVH, we sought to investigate the …

Management Of Asymptomatic Hypertension In The Inpatient Setting., Charles Meadows, Mehiar Elhamdani, Dial Larry, Murad Kheetan, Khaled Al-Baqain

Marshall Journal of Medicine

Hypertension is common in hospitalized patients and is most often asymptomatic. While there are no guidelines for management of such patients, aggressive blood pressure treatment, including the use of intravenous antihypertensives, is often undertaken. While evidence of benefit is lacking, emerging data suggest that treatment of asymptomatic hypertension in the inpatient setting is associated with adverse outcomes, including acute kidney injury and ischemic stroke. In addition, the intensification of a preexisting antihypertensive regimen at hospital discharge significantly increases the risk of readmission without significant improvement in outpatient hypertension control. Such a combination of a common problem with the demonstrable benefit …

Hubungan Status Vitamin D Dengan Risiko Jatuh Pada Pasien Lansia Dengan Penyakit Ginjal Kronik Yang Menjalani Hemodialisis Reguler, Muhammad Iqbal, Dina Aprillia Ariestine, Sumi Ramadhani

Jurnal Penyakit Dalam Indonesia

Introduction. Fall is one of the main causes of hospitalization in the elderly, which is caused by several factors including gait disturbances, balance disorders, visual disturbances, chronic kidney disease (CKD), vitamin D deficiency, and so on. Chronic kidney disease can cause disruption of vitamin D metabolism, especially in the elderly population. This study aimed to assess the relationship between vitamin D status and the risk of falling in elderly patients with CKD who receive regular hemodialysis programs.

Methods. We conducted a cross-sectional study by assessing the relationship between vitamin D status and the risk of fall in elderly patients undergoing …

Constant Site Hemodialysis In The Pediatric Population: Successful Use Of Vwings In Three Patients, Jordy Salcedo-Giraldo, Maxwell Kilcoyne, Chi Chi Do-Nguyen, Achintya Moulick, Susan Conley, Paul Brady, Vicki Mahan, Randy Stevens

Transformative Medicine (T-Med)

Introduction: Reliable vascular access for hemodialysis is challenging in the pediatric population. The Venous Window Needle Guide (VWING; Vital Access Corp, Salt Lake City, Utah) is an implanted surgical device that allows for constant site access but has not been reported in pediatric patients.

Case description: Three patients under 18 years of had a brachiobasilic fistula created with a minimum of 6 weeks for fistula maturation prior to VWING placement. This paper describes the management of constant site dialysis using VWING as well as strategies used for successful long-term management. Patients include a 15-year-old male with end-stage renal disease (ESDR) …

Persistent Increase In Serum Ferritin Levels Despite Converting To Permanent Vascular Access In Pediatric Hemodialysis Patients: Pediatric Nephrology Research Consortium Study., Ali Mirza Onder, Md Abu Yusuf Ansari, Fang Deng, Matthew M. Grinsell, Larry Patterson, Jennifer Jetton, Sahar Fathallah-Shaykh, Daniel Ranch, Diego Aviles, Lawrence Copelovitch, Eileen Ellis, Vimal Chadha, Ayah Elmaghrabi, Jen-Jar Lin, Lavjay Butani, Maha Haddad, Olivera Marsenic, Paul Brakeman, Raymond Quigley, H Stella Shin, Rouba Garro, Rupesh Raina, Craig B. Langman

Manuscripts, Articles, Book Chapters and Other Papers

Our objective was to examine serum ferritin trends after conversion to permanent vascular access (PVA) among children who started hemodialysis (HD) using tunneled cuffed catheters (TCC). Retrospective chart reviews were completed on 98 subjects from 20 pediatric HD centers. Serum ferritin levels were collected at the creation of PVA and for two years thereafter. There were 11 (11%) arteriovenous grafts (AVG) and 87 (89%) arteriovenous fistulae (AVF). Their mean TCC use was 10.4 ± 17.3 months. Serum ferritin at PVA creation was elevated at 562.64 ± 492.34 ng/mL, increased to 753.84 ± 561.54 ng/mL (p = < 0.001) in the first year and remained at 759.60 ± 528.11 ng/mL in the second year (p = 0.004). …

Brash Syndrome Case Report And Brief Review, Kelly Schuitema

Stratford Campus Research Day

BRASH syndrome is an acronym that stands for bradycardia, renal failure, AV node blocker, shock and hyperkalemia. The syndrome is precipitated by synergism from AV nodal blocking agents and hyperkalemia. The combination of the AV nodal blockade and renal failure leads to a cycle of severe bradycardia and hyperkalemia. We will discuss a case of BRASH syndrome with a 68 year old female who presented with generalized weakness and was found to be hypotensive, bradycardia, in acute renal failure with hyperkalemia likely related to metoprolol and amlodipine use.