American journal of kidney diseases : the official journal of the National Kidney Foundation
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Multiple factors associated with hypocitraturia have been identified. However, limited studies addressing the causal relationship to hypocitraturia are available. We therefore conducted this study to determine factors associated with hypocitraturia and show their causal relationship in recurrent calcium stone formers. ⋯ Hypocitraturia was found to be a common risk factor associated with recurrent calcium stone formation and low urinary potassium level, low alkaline absorption, low urinary calcium level, and high titratable acid excretion. Hypocitraturia is predominantly of dietary origin. Estimation of fruit intake should be included in the metabolic evaluation for recurrent calcium stone formation.
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Kidney dysfunction in the intensive care unit (ICU) results in increased morbidity, mortality, and health care costs; however, long-term mortality has not been described across strata of severity in kidney dysfunction. ⋯ Severity of kidney dysfunction in patients in the ICU is associated with an incremental increase in long-term mortality. Although patients classified with either mild or moderate kidney dysfunction had an increased risk for death, use of serum creatinine level alone was poor at discriminating long-term outcome, suggesting this measure alone should not be used for defining long-term prognosis.
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Radiocontrast-induced nephropathy (RCIN) causes acute kidney injury and increases mortality. Studies have examined the capacity of various forms of extracorporeal blood purification therapies for the prevention of RCIN, with conflicting results. We conducted a systematic review of published trials to determine whether periprocedural extracorporeal blood purification prevents RCIN. ⋯ This critical analysis of the published literature suggests that periprocedural extracorporeal blood purification does not decrease the incidence of RCIN compared with standard medical therapy.
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Comparative Study
Comparison of 2 acute renal failure severity scores to general scoring systems in the critically ill.
Several proposed definitions for acute renal failure (ARF) exist, but little is known of their significance in clinical practice. We evaluated the ability to predict hospital mortality in 2 ARF-specific severity-of-illness scoring methods, the Risk, Injury, Failure, Loss, End-Stage Renal Disease (RIFLE) score and the score presented by Bellomo et al in 2001. ⋯ Neither of the ARF-specific scoring methods presented good discriminative power regarding hospital mortality. However, maximum RIFLE score for the first 3 days in the ICU was found to be an independent predictor of hospital mortality, along with admission SOFA score.