American journal of kidney diseases : the official journal of the National Kidney Foundation
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Biochemistry and microscopy of urine are widely published diagnostic activities in patients with acute renal failure (ARF). However, their scientific basis in patients with septic ARF has not been assessed systematically. ⋯ The scientific basis for the use of urinary biochemistry, indices, and microscopy in patients with septic ARF is weak. More research is required to describe their accuracy, pattern, and time course in patients with septic ARF.
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Racial and ethnic differences in prevalence of albuminuria in a nationally representative population with and without diabetes were assessed. ⋯ Racial and ethnic minorities have greater odds of albuminuria than whites with and without diabetes, which persists primarily for those with an eGFR less than 60 mL/min/1.73 m(2).
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One of the less well-defined complications of familial dysautonomia (FD) is chronic kidney disease (CKD). The goal of this report is to better define the prevalence and severity of kidney disease in this population and identify associated risk factors. ⋯ Patients with FD are far more likely than the general population to develop CKD. Patients with FD who eventually required dialysis showed a greater degree of orthostatic hypotension and were significantly less likely to have had a feeding gastrostomy tube placed for hydration before the age of 15 years. Dialysis therapy is not well tolerated in this population.
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Risk factors for postoperative acute kidney injury (AKI) are well described in nontransplantation settings. Data regarding risks and consequences of AKI after cardiac transplantation are unclear. ⋯ AKI is associated with significant morbidity and mortality after cardiac transplantation. Predictors of AKI can be used to risk-stratify patients to ameliorate further kidney injury and offer a survival benefit.
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Different methods of regional anticoagulation using citrate in continuous hemofiltration have been described. To date, only such surrogate parameters as pH, anion gap, total calcium concentration, or total calcium-ionized calcium ratio have been proposed to reflect increased plasma citrate levels and thus risk for side effects. However, none of these parameters has been correlated with plasma citrate levels in critically ill patients. ⋯ Calculating total calcium-ionized calcium ratio is a simple tool that correlates best with citrate plasma levels. We recommend close monitoring of this parameter in all patients administered high doses of citrate as part of regional anticoagulation protocols.