The Netherlands journal of medicine
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There is limited evidence to support cytotoxic therapy in patients with IgA nephropathy and renal insufficiency. We studied the effect of cytotoxic therapy in patients with IgA nephropathy and renal insufficiency, and evaluated possible predictors of response. ⋯ Prolonged immunosuppressive therapy with cytotoxic agents and prednisone may benefit a subgroup of patients with progressive IgA nephropathy. A reduction of proteinuria ≥ 50% to levels below 1 g÷day within six months predicts a favourable long-term response.
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The decision-making process of dialysis initiation in the elderly involves different considerations compared with younger patients. Cognitive, functional and psychosocial issues are likely to be more important than standard prognostic factors. To assess the role of these issues in the decision-making process regarding dialysis initiation in the elderly, a survey was conducted among nephrologists in the Netherlands. ⋯ Although cognitive, functional and psychosocial issues are considered relevant items in the context of dialysis initiation in the elderly, systematic assessment of these items is not standard of care in nephrology practice. Future research is needed to determine whether a more systematic screening for the presence of geriatric impairments can improve the decision-making process.
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In recent years, requests for rabies immunoglobulin have increased at Amsterdam's Academic Medical Center's travel clinic. Travellers who received rabies pre-exposure prophylaxis (PrEP) before travel departure have immunological memory that can quickly be activated by timely booster vaccinations after possible exposure to rabies. PrEP alleviates the need for costly and scarcely available rabies immunoglobulin in case of exposure. This study describes which travellers are at risk of rabies exposure and would benefit from PrEP. The secondary aim was to specify which factors influence decision-making on taking PrEP. ⋯ Travellers t o Southeast Asia should particularly be informed about rabies and the possibility of PrEP. Long-term travel was not associated with a higher risk of rabies exposure.