Kidney international
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Kidney international · Feb 2005
Multicenter StudyPediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy.
Critical illness leading to multi-organ dysfunction syndrome (MODS) and associated acute renal failure (ARF) is less common in children compared to adult patients. As a result, many issues plague the pediatric ARF outcome literature, including a relative lack of prospective study, a lack of modality stratification in subject populations and inconsistent controls for patient illness severity in outcome analysis. ⋯ We suggest that after initial resuscitative efforts, an increased emphasis should be placed on early initiation of CRRT and inotropic agent use over fluid administration to maintain acceptable blood pressure.
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Kidney international · Feb 2005
Radionuclide method for evaluating the performance of hemodialysis in vivo.
Specifications of dialyzer performance are generally based on in vitro measurements. There is, however, a shortage of data on dialyzer performance in vivo. The aim of this study was to use continuous measurement of technetium-99m-diethyltriaminepentaacetic acid (Tc-99m-DTPA) blood concentration as a means of continuously monitoring dialyzer function in vivo in patients undergoing routine hemodialysis. ⋯ Tc-99m-DTPA is a useful agent for continuously monitoring dialyzer function in vivo and provides a platform for the use of other radio-pharmaceuticals of different molecular sizes that could be used in an analogous fashion.
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Kidney international · Jan 2005
ReviewPolymorphism of host response genes: implications in the pathogenesis and treatment of acute renal failure.
Acute inflammatory disorders are the result of an interaction between genetic and environmental factors, and are often characterized by an imbalance between pro- and anti-inflammatory host immune responses. Over the past decade, polymorphisms of host response genes have been explored as genetic risk and prognostic markers in the course and severity of acute inflammatory disorders. ⋯ This review summarizes the existing experimental and clinical studies supporting the role of inflammation in ARF and critically appraises studies that have examined polymorphism of immune response genes as potential determinants of susceptibility to and severity of acute inflammatory disorders. Conclusions are drawn on the application of genetic epidemiology to the field of ARF and the rationale for further research on the role of genetic markers in ARF.
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Kidney international · Jan 2005
Randomized Controlled Trial Clinical TrialB-type natriuretic peptide for acute dyspnea in patients with kidney disease: insights from a randomized comparison.
B-type natriuretic peptide (BNP) levels are reliably elevated in patients with congestive heart failure (CHF) and therefore helpful in its diagnosis. However, kidney disease results in elevated BNP levels independently of CHF. Accordingly, the impact of kidney disease on the benefit of BNP testing needs to be scrutinized. ⋯ When applying BNP cut-off values without adjustment for the presence of kidney disease, the use of BNP levels does significantly improve the management of patients without kidney disease, but not of those with kidney disease.
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Kidney international · Jan 2005
Vasopressin-independent regulation of collecting duct aquaporin-2 in food deprivation.
Humans and animals are frequently subjected to food deprivation or starvation. However, the adaptation of the kidney to this condition is not well understood. The purpose of these studies was to examine the effects of food deprivation on water handling by the kidney, the expression levels of collecting duct (CD) water channel aquaporin-2 (AQP2), and to determine the role of vasopressin in the adaptation of AQP2 to food deprivation. ⋯ Food deprivation impairs water handling by the kidney by causing dual changes in urine volume and urine osmolality. This effect is associated with parallel alterations in the expression of AQP2 and is independent of vasopressin activity. It is concluded that the increase in water reabsorption in the CD is an adaptive response of the kidney to a long period of food deprivation and is mediated via a vasopressin-independent mechanism.