American journal of kidney diseases : the official journal of the National Kidney Foundation
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"Bath salts" are becoming recognized as a frequently abused and highly addictive substance that can be obtained legally in some areas. These agents contain stimulant compounds, such as methylenedioxopyrrovalerone and mephedrone, that have been associated with sympathomimetic effects and psychotic features, such as paranoia, delusions, agitation, and confusion. ⋯ The patient, who presented with neurologic and cardiovascular symptoms and signs, also developed rhabdomyolysis, hyperuricemia, and metabolic acidosis as part of the clinical presentation. Bath salts intoxication should be included on the list of substances that can cause acute kidney injury and other metabolic abnormalities.
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Randomized Controlled Trial Multicenter Study Comparative Study
A randomized trial comparing gentamicin/citrate and heparin locks for central venous catheters in maintenance hemodialysis patients.
Central venous catheters (CVCs) are used for vascular access in hemodialysis patients who have no alternative access or are awaiting placement or maturation of a permanent access. The major complications of CVCs are catheter-related bloodstream infection and clotting in the catheter lumen. ⋯ Gentamicin 320 μg/mL in 4% sodium citrate used as a routine catheter lock in CVCs in patients on maintenance hemodialysis therapy markedly decreases the incidence of catheter-related bloodstream infection and is as effective as heparin 1,000 U/mL in preventing catheter clotting.
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Randomized Controlled Trial
Oral calcitriol for reduction of proteinuria in patients with IgA nephropathy: a randomized controlled trial.
Vitamin D has shown efficacy in the reduction of proteinuria in patients with chronic kidney disease. This study aimed to determine the effect of calcitriol on urinary protein excretion in patients with immunoglobulin A (IgA) nephropathy. ⋯ The addition of calcitriol to a renin-angiotensin system inhibitor resulted in a safe decrease in proteinuria in patients with IgA nephropathy.
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Previous studies have shown that patients with chronic kidney disease, including those with diabetic nephropathy, are more likely to die of cardiovascular disease than reach end-stage renal disease (ESRD). This analysis was conducted to determine whether ESRD is a more common outcome than cardiovascular death in patients with type 2 diabetic nephropathy, significant proteinuria, and decreased kidney function who were selected for participation in a clinical trial. ⋯ Patients with type 2 diabetic nephropathy, characterized by decreased kidney function and significant proteinuria, are more likely to reach ESRD than die during 3 years' mean follow-up. Given the rapidly increasing number of cases of type 2 diabetes worldwide, this has implications for predicting future renal replacement therapy requirements.
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Review Case Reports
Decongestive treatment of acute decompensated heart failure: cardiorenal implications of ultrafiltration and diuretics.
In patients with acute decompensated heart failure (ADHF), treatment aimed at adequate decongestion of the volume overloaded state is essential. Despite diuretic therapy, many patients remain volume overloaded and symptomatic. In addition, adverse effects related to diuretic treatment are common, including worsening kidney function and electrolyte disturbances. ⋯ Many questions remain regarding the comparative impact of diuretics and ultrafiltration on important clinical outcomes and adverse effects, including decreased kidney function. This article serves as a summary of key clinical studies addressing these points. The overall goal is to assist practicing clinicians who are contemplating the use of ultrafiltration for a patient with ADHF.