Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
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Nephrol. Dial. Transplant. · Jul 2012
Case Reports Meta AnalysisRight atrial thrombi complicating haemodialysis catheters. A meta-analysis of reported cases and a proposal of a management algorithm.
Little is known about the potentially fatal complication of catheter-related right atrial thrombus (CRAT) in dialysis patients, and the optimal management is controversial. The aims of our study were to identify the prognostic factors of mortality in cases of CRAT in dialysis patients and to compare treatment options. ⋯ We propose a management algorithm emphasizing the removal of the catheter and recommending anticoagulation as first-line treatment. Surgical thrombectomy is valuable when other treatments fail or in special circumstances. Thrombolysis has a poor success rate but may be useful in pulmonary embolism.
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Nephrol. Dial. Transplant. · Jul 2012
Progression to hypertension in non-hypertensive children following renal transplantation.
The aim of this study was to evaluate in non-hypertensive children following renal transplantation (TX) the rates and determinants of transition to hypertension. ⋯ Just over 49% of our initially non-hypertensive patients progressed to hypertension following TX. BP needs careful monitoring post-TX and ideally should be maintained in the 'normal' and 'optimal' range.
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Nephrol. Dial. Transplant. · Jul 2012
Impact of nephrotic edema of the lower limbs on obstructive sleep apnea: gathering a unifying concept for the pathogenetic role of nocturnal rostral fluid shift.
Nocturnal rostral fluid shift has been suggested to be a risk factor for obstructive sleep apnea (OSA) in healthy subjects after lower body positive pressurization. It remains unclear whether this may apply to subjects with nephrotic lower limb edema and, if so, whether disease remission may reverse the accompanying OSA. ⋯ Nephrotic lower limb edema is associated with disturbed respiratory breathing and increased propensity to OSA, which was reversed upon remission of the nephrosis. This gathers a unifying concept for the role of nocturnal rostral fluid shift in the pathogenesis of OSA.
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Nephrol. Dial. Transplant. · Jul 2012
Timing of initiation of renal replacement therapy for acute kidney injury: a survey of nephrologists and intensivists in Canada.
Little is known about factors that influence the timing of initiation of renal replacement therapy (RRT) for acute kidney injury (AKI). We sought to better describe these factors for Canadian physicians that prescribe RRT for AKI. ⋯ These results provide insight into clinical and laboratory factors that influence the timing of initiation of RRT for AKI and may aid in the design of future trials. While most clinicians consider the degree of hyperkalemia and pulmonary edema in deciding when to initiate RRT for AKI, there is a wide range of clinical practice, uncertainty regarding the optimal timing of initiation and enthusiasm for prospective interventional studies to address this topic.
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Nephrol. Dial. Transplant. · Jul 2012
Association of apolipoprotein A1 and B with kidney function and chronic kidney disease in two multiethnic population samples.
Circulating lipoproteins and their protein constituents, apolipoproteins, are risk factors for chronic kidney disease (CKD). The associations between apolipoprotein A1, apolipoprotein B and their ratio with glomerular filtration rate estimated from the new CKD Epidemiology Collaboration (CKD-EPI) equation (eGFR) are not well studied in the general population. ⋯ Higher serum apolipoprotein A1 was associated with lower prevalence of CKD and higher eGFR estimated by the CKD-EPI equation in two large multiethnic population-based samples. While apolipoprotein B showed no consistent associations, a higher apolipoprotein B/A1 ratio was significantly associated with lower eGFR in both studies. The direction and magnitude of the longitudinal associations between apolipoproteins and CKD incidence were overall similar to those observed cross-sectionally. No consistent differences became apparent between traditional lipids and apolipoproteins.