Renal failure
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Review Meta Analysis
Timing of initiation of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis.
The aim of the study is to summarize the effects of timing of initiation of renal replacement therapy (RRT) on mortality. ⋯ "Early" CRRT and "early" IHD both could reduce the mortality of patients with acute kidney injury compared with "late" CRRT or IHD.
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Review Case Reports
Early use of hemodialysis for active rewarming in severe hypothermia: a case report and review of literature.
Deep accidental hypothermia (body temperature below 28°C) is rare. Even with modern supportive care of active external and internal rewarming techniques it is associated with a high mortality rate. We report the early and successful use of hemodialysis (HD) for active rewarming of a middle-aged alcoholic man with severe deep accidental hypothermia after failure of initial efforts of rewarming using conventional strategies. This case report and review of the literature highlights the advantages and the challenges of using HD in this setting and suggests a potential role for HD in the routine management of severe hypothermia in the absence of circulatory arrest.
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Neutrophil gelatinase-associated lipocalin (NGAL) has generated great interest as a novel biomarker for the timely detection of acute kidney injury (AKI). Despite the enthusiasm surrounding NGAL, the research so far details and attempts to minimize a host of limitations that substantially preclude its use as a valuable diagnostic biomarker to detect AKI and guide clinical treatment. ⋯ Furthermore, there are not well-defined cutoff values among various patient populations which would permit use of NGAL as a positive or negative diagnostic marker similar to troponin in cardiac injury. Moreover, due to the wide variation in baseline concentration of NGAL among patients, the added requirement of serial measurements, that may not even be accurate in at-risk or chronic kidney injury populations, further degrades the benefit of early detection.