Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
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Nephrol. Dial. Transplant. · May 2010
Intravenous conivaptan for the treatment of hyponatraemia caused by the syndrome of inappropriate secretion of antidiuretic hormone in hospitalized patients: a single-centre experience.
Intravenous conivaptan is a novel therapeutic agent indicated for the treatment of euvolaemic and hypervolaemic hyponatraemia. However, there is paucity of reported clinical experience using conivaptan for the treatment of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Moreover, while there is reasonable concern for overcorrection, no pre-treatment variables are known to be helpful to identify patients at risk for rapid correction. ⋯ We conclude that intravenous conivaptan is an effective aquaretic to treat hyponatraemia caused by SIADH, as evidenced by a simultaneous increase in serum sodium and decrease in urine osmolality. Baseline values of serum sodium, blood urea nitrogen and estimated glomerular filtration rate may help predicting the magnitude of response to therapy.
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Nephrol. Dial. Transplant. · May 2010
Translumbar central venous catheters for long-term haemodialysis.
Vascular access for haemodialysis is achieved by tunnelled central venous catheter (CVC) in at least 23% of prevalent patients in the UK, Canada and the USA. Use of CVCs is associated with an increased incidence of venous stenosis that can progressively limit future vascular access routes. Lack of conventional venous access routes mandates the use of alternative strategies such as the translumbar approach. ⋯ Translumbar inferior vena caval CVCs can offer relatively safe and effective long-term haemodialysis access in patients with no other options.
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Nephrol. Dial. Transplant. · May 2010
Using RIFLE criteria to evaluate acute kidney injury in brain-deceased kidney donors.
The limited supply of deceased donors for renal transplantation led to considering alternative strategies for making more organs available. One of these strategies is the use of donors with renal dysfunction, as this is usually a reversible condition. RIFLE (risk, injury, failure, loss and end-stage renal failure) criteria were developed to standardize the definition and severity of acute kidney injury (AKI) but have not been previously used in brain-deceased donors. We applied the RIFLE classification to evaluate renal function changes in our donor pool, in an attempt to know its influence in transplant outcome. ⋯ The RIFLE classification system offers us an opportunity to standardize and quantify renal injury in donors. Although >10% of brain-deceased donors can suffer AKI, these grafts can perform adequately. Hence, the development of AKI in donors cannot be an isolated criterion to discard kidney donation.
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Nephrol. Dial. Transplant. · May 2010
Case ReportsEffect of corticosteroids during ongoing drug exposure in pantoprazole-induced interstitial nephritis.
Acute interstitial nephritis (AIN) represents a significant cause of acute renal failure in hospital practice. An increasing number of drugs are known to cause AIN. Due to the lack of prospective, randomized clinical trials, the most effective management is still uncertain, especially the role of steroids in the resolution of interstitial nephritis remains to be further defined. ⋯ In spite of ongoing drug exposure, steroids led to almost complete resolution of the inflammatory infiltrates. Early diagnosis of interstitial nephritis by renal biopsy and identification of the causative drug and its withdrawal remains the mainstay of treatment. However, the additional use of steroids has the potential to eradicate inflammatory infiltrates more rapidly and completely and may thus be important to minimize subsequent chronic damage.