The Medical clinics of North America
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Patients with cancer may develop kidney disease with a variety of different clinical manifestations including acute kidney injury, chronic kidney disease, hypertension, proteinuria and electrolyte disturbances. Onco-nephrology is the subspecialty of nephrology that diagnoses and manages kidney disease in patients with cancer. In this article, we review major topics in Onco-Nephrology that may be encountered by the general internist.
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Med. Clin. North Am. · Jul 2023
ReviewOverview of Renal Transplantation for Primary Care Physicians: Workup, Complications, and Management.
Kidney transplantation remains the treatment of choice for eligible patients with end-stage kidney disease. The last few decades have seen an expansion in the transplant recipient pool with over 250,000 patients living with a kidney transplant today. ⋯ As a result, it is becoming increasingly important for primary care physicians to have a nuanced understanding of medications, complications, and chronic medical problems unique to transplant recipients. This article reviews the role of the primary care office in helping streamline the pretransplant evaluation process and long-term posttransplant care.
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Urinalysis is a widely used diagnostic tool to assist clinicians in determining the etiology of various acute or chronic pathologies. Primary care, general internal medicine, and family medicine clinicians should be adept at identifying indications for urinalyses, in addition to appropriately interpreting their results. In this article, we provide an overview of urinalysis for non-nephrologists.
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Med. Clin. North Am. · Jul 2023
ReviewHepatorenal Syndrome: Pathophysiology, Diagnosis, and Treatment.
Hepatorenal syndrome (HRS) is a primarily functional form of acute kidney injury (AKI) that develops in patients with decompensated cirrhosis. The pathophysiologic cascade that leads to HRS begins with pooling of blood in the splanchnic system, resulting in a decrease in effective circulating arterial volume. ⋯ When this is not possible, HRS is treated with a combination of vasoconstrictor agents and intravenous albumin. Although the combination of midodrine and octreotide is used in the United States, the recently approved terlipressin, an analog of vasopressin, is likely to become the first-line standard of care.
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Med. Clin. North Am. · Jul 2023
ReviewDiagnosis of Chronic Kidney Disease and Assessing Glomerular Filtration Rate.
Chronic kidney disease (CKD) is a silent progressive disease. It is diagnosed by assessing filtration and markers of kidney damage such as albuminuria. ⋯ The use of a combination of serum cystatin C and creatinine concentration offers a more accurate estimation of GFR. Social determinants of health are important to address as part of the diagnosis because they contribute to CKD disparities.