Nephrology Commons^™

Preoperative Angiotensin Converting Enzyme Inhibitor Or Angiotensin Receptor Blocker Use And Acute Dialysis: A Population Based Cohort Study, Mitesh K. Shah

Electronic Thesis and Dissertation Repository

Angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) use prior to major surgery is controversial. We performed a population based retrospective cohort study of 237,208 elderly patients (of whom 101,494 (42.8%) were ACEi or ARB users) who underwent major elective surgery from 1995 to 2010 in Ontario, Canada. The primary outcome was acute kidney injury treated with dialysis (AKI-D) within 14 days following surgery (810 (0.34%) patients). The secondary outcome was all-cause mortality within 90 days following surgery (11,089 (4.67%) patients). After adjusting for potential confounders, preoperative ACEi or ARB use was associated with a lower relative risk …

Novel Napi-Iic Mutations Causing Hhrh And Idiopathic Hypercalciuria In Several Unrelated Families: Long-Term Follow-Up In One Kindred., Y Yu, S R. Sanderson, M Reyes, A Sharma, N Dunbar, Tarak Srivastava, H Jüppner, C Bergwitz

Manuscripts, Articles, Book Chapters and Other Papers

Homozygous and compound heterozygous mutations in SLC34A3, the gene encoding the sodium-dependent co-transporter NaPi-IIc, cause hereditary hypophosphatemic rickets with hypercalciuria (HHRH), a disorder characterized by renal phosphate-wasting resulting in hypophosphatemia, elevated 1,25(OH)(2) vitamin D levels, hypercalciuria, rickets/osteomalacia, and frequently kidney stones or nephrocalcinosis. Similar albeit less severe biochemical changes are also observed in heterozygous carriers, which are furthermore indistinguishable from those encountered in idiopathic hypercalciuria (IH). We now searched for SLC34A3 mutations (exons and introns) in two previously not reported HHRH kindreds, which resulted in the identification of three novel mutations. The affected members of kindred A were compound heterozygous …

Acetaminophen Induced Steven Johnson Syndrome-Toxic Epidermal Necrolysis Overlap, Ali Khuwaja, Ahmed Shahab, Syed Ather Hussain

Section of Internal Medicine

Steven Johnson Syndrome and Toxic Epidermal Necrolysis are rare but severe form of hypersensitivity inflammatory reactions to multiple offending agents including drugs. Acetaminophen is extensively used due to its analgesic and anti-pyretic properties. It is rendered to be relatively safe, with hepatotoxicity considered to be the major adverse effect. However, very few cases of Steven Johnson Syndrome and Toxic Epidermal Necrolysis have been reported with acetaminophen usage in the past. We present the case of a 40 years old lady who developed an overlap of the two condition after taking several doses of acetaminophen for fever. She presented with widespread …

Vitamin D Levels In Asymptomatic Adults--A Population Survey In Karachi, Pakistan, Adil Sheikh, Zeb Saeed, Syed Ali Danial Jafri, Iffat Yazdani, Syed Ather Hussain

Section of Nephrology

Background: It is well established that low levels of 25(OH) Vitamin D (/dL) are a common finding world over, affecting over a billion of the global population. Our primary objective was to determine the prevalence of vitamin D deficiency and insufficiency in the asymptomatic adult population of Karachi, Pakistan and the demographic, nutritional and co-morbidity characteristics associated with serum vitamin D levels. Methods: A cross-sectional population survey was conducted at two spaced out densely populated areas of the city. Serum levels of 25OH vitamin D were measured and GFR as renal function was assessed by using 4 variable MDRD formula. …

Continuous Renal Replacement Therapy, Gulzar Salman Amlani

School of Nursing & Midwifery

Acute renal failure refers to sudden deterioration in biochemical and physiological functioning of kidneys and often associated with multi organ failure. Continuous renal replacement therapy (CRRT) holds special significance for the treatment of renal failure due to a variety of factors. It is believed that CRRT helps in restoration of acid-base imbalances and electrolyte abnormalities. Along with that, with gradual solute removal, it ensures haemodynamic stability and prevents the risk of cerebral oedema in neurosurgery patients. Besides this, several studies have supported that CRRT enables practitioners to adjust drug dosages and prevent drug accumulation and overdose. In addition, gradual removal …

Retrospective Comparison Of The Incidence Of Acute Kidney Injury In Patients Treated With Intravenous Polymyxin B Or Intravenous Colistimethate Sodium, Rebecca A. Sumner Pharmd, Jarrod W. Kile Rph, Bcps

Department of Pharmacy

No abstract provided.

Dialysis Rationing And The Just Allocation Of Resources: A Historical Primer., Teri Browne

Teri Browne

No abstract provided.

Jean-Martin Charcot - Neurologist By Avocation, Nephrologist By Yearning, Gary Eknoyan

Houston History of Medicine Lectures

In an age of medical advances and specialization, Jean-Martin Charcot (1825-1893) helped found the discipline of neurology and in 1882 was appointed the first professor of Diseases of the Nervous System in France. As an investigator with broad interests and vast knowledge Charcot contributed to several other disciplines. An early mentor and dominant figure in Charcot's formative years was Pierre Rayer (1793-1867), famous for his seminal contributions to the study of the kidney, who gifted Charcot with his passion for clinical pathological correlations and likely a yearning for the study of kidney diseases. Famous for the clarity and incisiveness of …

Use Of Traditional Chinese Medication For Post-Stroke Recovery, Shaista Anwar Sidddiqi, Ayeesha Kamran Kamal

Section of Nephrology

No abstract provided.

Supplementary Information For "Outcomes Of Early Versus Late Nephrology Referral In Chronic Kidney Disease – A Systematic Review.", Neil Smart, Thomas Titus

Neil Smart

NB. The following files containing supplementary information relating to "Outcomes of Early Versus Late Referral in Chronic Kidney Disease Patients; A Systematic Review." published in the Americam journal of Medicine Sept. 2011 can be viewed at the foot of the page.

Figure 1. Three Month Mortality

Figure 2. Five Year Mortality

Figure 3. Hemoglobin

Figure 4. Erythropoietin

Figure 5. Serum Creatinine

Table 1. Search strategy

Table 2. Characteristics of Included Studies

Urinary Nitrate Might Be An Early Biomarker For Pediatric Acute Kidney Injury In The Emergency Department, Asad Mian, Yue Du, Harsha K Garg, Chantal Caviness, Stuart L Goldstein, Nathan S Bryan

Department of Emergency Medicine

NO is involved in normal kidney function and perturbed in acute kidney injury (AKI). We hypothesized that urinary concentration of NO metabolites, nitrite, and nitrate would be lower in children with early AKI presenting to the emergency department (ED), when serum creatinine (SCr) was uninformative. Patients up to 19 y were recruited if they had a urinalysis and SCr obtained for routine care. Primary outcome, AKI, was defined by pediatric Risk, Injury, Failure, Loss of function, End-stage renal disease (pRIFLE) criteria. Urinary nitrite and nitrate were determined by HPLC. A total of 252 patients were enrolled, the majority (93%) of …

Assessment Of Adherence To Guidelines For Hepatocellular Carcinoma Screening In Hiv/Hcv Coinfected Patients, Jonathan M. Fenkel, Md, Victor J. Navarro, Md

Division of Gastroenterology and Hepatology Faculty Papers

Conclusions:

1. Self-reported adherence with published guidelines for HCC screening is poor among primary providers for HIV/HCV coinfected patients, including HIV specialists and University-based providers.

2. Unnecessary imaging is also frequently ordered on non-cirrhotics, particularly by University-based providers.

3. Improved adherence to guidelines is needed among primary providers as over 50% of HCC's may be missed, and many patients many not be referred for subspecialty GI or Liver care, where screening practices may differ.

Primary Provider Beliefs And Practice Patterns Contribute To The Lack Of Hiv/Hcv Coinfected Patients Undergoing Liver Transplantation In The United States, Jonathan M. Fenkel, Md, Victor J. Navarro, Md

Division of Gastroenterology and Hepatology Faculty Papers

Conclusions:

1. The majority of primary providers were ambivalent toward or against LT for HIV/HCV coninfected patients.

2. Half of all respondents were unlikely to refer cirrhotic coinfected patients for LT evaluation.

3. HIV specialists were significantly more likely to believe transplant should be offered, but reported no difference in likelihood of LT referral.

4. These findings suggest that primary provider beliefs and self-reported practice patterns may partially explain the paucity of coinfected US liver transplant recipients.

Superficial Temporal Artery Calcification In Patients With End-Stage Renal Disease: Association With Vascular Risk Factors And Ischemic Cerebrovascular Disease, Zeeshan Anwar, Elcin Zan, Marco Carone, Arzu Ozturk, Stephen M Sozio, David M Yousem

Department of Medicine

Background And Purpose: Extracranial superficial temporal artery (STA) calcification is an unusual finding seen in Patients with chronic kidney disease and has unknown ramifications with respect to intracranial ischemic disease. We sought to determine the association between the risk factors for vascular calcification and this rare phenomenon, in Patients with chronic renal failure, and to assess the coexistence of cerebral ischemia. Materials And Methods: Medical records and laboratory data on risk factors for vascular calcification were retrospectively retrieved for 453 Patients with a discharge diagnosis of end-stage renal disease (ESRD). CT head examinations were reviewed to identify and associate STA …

A Phase I/Iia Clinical Trial Of A Recombinant Rho Protein Antagonist In Acute Spinal Cord Injury., Michael G Fehlings, Nicholas Theodore, James Harrop, Gilles Maurais, Charles Kuntz, Chris I Shaffrey, Brian K Kwon, Jens Chapman, Albert Yee, Allyson Tighe, Lisa Mckerracher

Department of Neurosurgery Faculty Papers

Multiple lines of evidence have validated the Rho pathway as important in controlling the neuronal response to growth inhibitory proteins after central nervous system (CNS) injury. A drug called BA-210 (trademarked as Cethrin(®)) blocks activation of Rho and has shown promise in pre-clinical animal studies in being used to treat spinal cord injury (SCI). This is a report of a Phase I/IIa clinical study designed to test the safety and tolerability of the drug, and the neurological status of patients following the administration of a single dose of BA-210 applied during surgery following acute SCI. Patients with thoracic (T2-T12) or …

Goldston Syndrome, Zainab Hussain, Imrana Masroor, Qurrat-Ul-Ain Haider, Tariq Alam

Department of Radiology

Goldston syndrome is a rare entity describing the association of polycystic kidneys and Dandy Walker malformation with or without hepatic fibrosis. A 28 years old pregnant woman came to radiology department for the first antenatal scan. Ultrasound showed a single fetus corresponding to 27 week of gestation. The fetal brain revealed deficient vermis with a posterior fossa cyst communicating with the 4th ventricle suggestive of Dandy-Walker malformation (DWM). The kidneys were enlarged, and echogenic containing small cysts with associated amniotic fluid index of 5 cm suggestive of Oligohydramnios. A diagnosis of Goldston syndrome was suggested. These findings were confirmed on …

Helicobacter Pylori: Association With Gall Bladder Disorders In Pakistan, Javed Yakoob, M. R. Khan, Z. Abbas, W. Jafri, R. Azmi, Z. Ahmad, S. Naeem, L. Lubbad

Department of Medicine

Helicobacter species colonise the biliary tract and therefore this study explores the relationship between of Helicobacter pylori and cholecystitis. Bile and gall bladder tissue samples were obtained from 144 Patients who underwent cholecystectomy. Of these, 89 had chronic cholecystitis with cholelithiasis, 44 had gall bladder carcinoma and 11 had gall bladder polyps. Histopathology examination included special staining and immunohistochemistry (IHC), while Helicobacter species (H. pylori, H. bilis and H. hepaticus) were detected by the polymerase chain reaction (PCR). Sequencing and BLAST query of PCR products was undertaken and samples were considered to contain H. pylori if both PCR and IHC …

The Characteristics Of Successful Evidence Retrieval By Nephrologists And The Impact Of Pubmed Search Filters, Salimah Shariff

Electronic Thesis and Dissertation Repository

Background: Clinicians frequently search PubMed to guide patient care. This study investigated the factors that impact successful searching and the utility of PubMed search filters.

Methods: A random sample of nephrologists was surveyed between 2008 and 2010; 160 valid responses were received (72% response rate). One group of 60 respondents was presented with the same two clinical questions, while the other 100 were each presented with a unique clinical question. The clinical questions were based on recently published systematic reviews. Respondents provided the search terms they would type into PubMed to address their clinical question(s). All physician-provided searches …

Rho Activation Of Mdia Formins Is Modulated By An Interaction With Inverted Formin 2 (Inf2), Hua Sun, Johannes S. Schlondorff, Elizabeth J. Brown, Henry N. Higgs, Martin R. Pollak

Dartmouth Scholarship

Inverted formin 2 (INF2) encodes a member of the diaphanous subfamily of formin proteins. Mutations in INF2 cause human kidney disease characterized by focal and segmental glomerulosclerosis. Disease-causing mutations occur only in the diaphanous inhibitory domain (DID), suggesting specific roles for this domain in the pathogenesis of disease. In a yeast two-hybrid screen, we identified the diaphanous autoregulatory domains (DADs) of the mammalian diaphanous-related formins (mDias) mDia1, mDia2, and mDia 3 as INF2_DID-interacting partners. The mDias are Rho family effectors that regulate actin dynamics. We confirmed in vitro INF2_DID/mDia_DAD binding by biochemical assays, confirmed the in vivo interaction of these …

Serum 25-Hydroxyvitamin D Level And Acute-Phase Reaction Following Initial Intravenous Bisphosphonate., Tarak Srivastava, Hongying Dai, Connie J. Haney, Uri S. Alon

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.