American journal of kidney diseases : the official journal of the National Kidney Foundation
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The optimal timing of nephrology consultation in patients with hospital-acquired acute kidney injury (AKI) is unknown. ⋯ Early nephrologist involvement in patients with AKI may reduce the risk of a further decrease in kidney function. A larger randomized trial is needed to confirm the findings.
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Chronic kidney disease (CKD) is associated with poor renal and cardiovascular outcomes, and early identification largely depends on general practitioners' (GPs') awareness of it. To date, no study has evaluated CKD prevalence in patients with hypertension in primary care. ⋯ Awareness of CKD by GPs is critical for achieving the recommended guideline BP targets. However, awareness of CKD by GPs is still far too low, highlighting the need to systematically adopt eGFR for more accurate identification of CKD in high-risk populations.
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Review Case Reports
Intra-abdominal Hypertension and Abdominal Compartment Syndrome.
Increased intra-abdominal pressure (IAP), also referred to as intra-abdominal hypertension (IAH), affects organ function in critically ill patients and may lead to abdominal compartment syndrome (ACS). Although initially described in surgical patients, IAH and ACS also occur in medical patients without abdominal conditions. IAP can be measured easily and reliably in patients through the bladder using simple tools. ⋯ An integrated approach targeting IAH may improve outcomes and decrease hospital costs, and IAP monitoring is a first step toward dedicated IAH management. IAH prevention, most importantly during abdominal surgery but also during fluid resuscitation, may avoid ACS altogether. However, when ACS occurs and medical treatment fails, decompressive laparotomy is the only option.
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Review Case Reports
Asymptomatic large extracapsular renal pseudoaneurysm following kidney transplant biopsy.
Vascular complications after kidney biopsy include hematomas, arteriovenous fistulas, and pseudoaneurysms. Ultrasonography is a useful tool for the diagnosis of these complications, and color Doppler scan is effective at distinguishing among them. We describe a transplant patient who underwent percutaneous kidney biopsy in whom echography performed after biopsy showed a pulsatile hypoechoic perinephric mass of 4.4 cm. ⋯ Supraselective coil embolization of the artery feeding the pseudoaneurysm was performed successfully in our patient. Pseudoaneurysm can mimic renal cysts on gray-scale ultrasound. We suggest that Doppler sonography be performed in cystic areas detected after biopsy to exclude pseudoaneurysm.
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Randomized Controlled Trial
Effect of remote ischemic preconditioning on acute kidney injury in nondiabetic patients undergoing coronary artery bypass graft surgery: a secondary analysis of 2 small randomized trials.
Novel treatment strategies are required to reduce the development of acute kidney injury (AKI) in patients undergoing cardiac surgery. In this respect, remote ischemic preconditioning (RIPC), a phenomenon in which transient nonlethal ischemia applied to an organ or tissue protects another organ or tissue from subsequent lethal ischemic injury, is a potential renoprotective strategy. ⋯ RIPC induced using transient forearm ischemia decreased the incidence of AKI in nondiabetic patients undergoing elective CABG surgery in this retrospective analysis. A large prospective clinical trial is required to study this effect and clinical outcomes in patients undergoing cardiac surgery.