Contributions to nephrology
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Review
Serum free light chains in the diagnosis and monitoring of patients with plasma cell dyscrasias.
Serum free light chain assay is a recently available test for diagnosis and monitoring of patients with plasma cell dyscrasias. In particular, this test is especially useful in patients that were previously difficult to follow with traditional laboratory methods. ⋯ Potential uses include assessing progression of patients with monoclonal gammopathy of undetermined significance, smoldering multiple myeloma, solitary bone plasmacytoma and extramedullary plasmacytoma to multiple meyloma. Analytical considerations for the assay are also discussed.
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Acute kidney injury (AKI) is a major clinical problem with a rising incidence and high mortality rate. The lack of early biomarkers has resulted in an unacceptable delay in initiating therapies. ⋯ As they represent tandem biomarkers, it is likely that the AKI panels will be useful for timing the initial insult and assessing the duration and severity of AKI. Based on the differential expression of the biomarkers, it is also likely that the AKI panels will distinguish between the various types and etiologies of AKI. It will be important in future studies to validate the sensitivity and specificity of these biomarker panels in clinical samples from large cohorts and from multiple clinical situations.
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Review
Renal assist device and treatment of sepsis-induced acute kidney injury in intensive care units.
Acute kidney injury (AKI) is a frequent and serious complication of sepsis in ICU patients and is associated with a very high mortality. Despite the advent of sophisticated renal replacement therapies (RRT) employing high-dose hemofiltration and high-flux membranes, mortality and morbidity from sepsis-induced AKI remained high. ⋯ The results from the in vitro and preclinical animal model studies were very intriguing and led to the development of a bioartificial kidney consisting of a renal tubule assist device containing human proximal tubular cells (RAD) added in tandem to a continuous venovenous hemofiltration circuit. The results from the phase I safety trial and the recent phase II clinical trial showed that the RAD not only can replace many of the indispensable biological kidney functions, but also modify the natural history of sepsis-induced AKI by ameliorating patient survival.
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The acute renal failure (ARF) incidence in pediatric cardiac surgery intensive care unit (ICU) ranges from 5 to 20% of patients. In particular, clinical features of neonatal ARF are mostly represented by fluid retention, anasarca and only slight creatinine increase; this is the reason why medical strategies to prevent and manage ARF have limited efficacy and early optimization of renal replacement therapy (RRT) plays a key role in the outcome of cardiopathic patients. ⋯ PD is a safe and adequate strategy to support ARF in neonates with congenital heart disease. Fluid balance control is easily optimized by this therapy whereas solute control reaches acceptable levels.