Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
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Nephrol. Dial. Transplant. · Jun 2013
Urinary sodium excretion is the main determinant of mineralocorticoid excretion rates in patients with chronic kidney disease.
Blockade of the mineralocorticoid receptor (MR) in patients with chronic kidney disease (CKD) improves surrogate cardiovascular outcomes, such as left ventricular mass. Animal models of renal disease support a pathological role of mineralocorticoids, in the context of a high sodium intake. We aimed to assess the regulation of mineralocorticoid biosynthesis in patients with CKD. ⋯ In patients with CKD, 24-h urinary sodium excretion is the strongest positive predictor of urinary mineralocorticoid excretion. The nature of this relationship is unexpected, novel, not seen in patients with EH and may explain the association seen between high urinary sodium excretion, mineralocorticoids and poor outcomes in patients with CKD.
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Nephrol. Dial. Transplant. · Jun 2013
ReviewContrast-induced acute kidney injury: how much contrast is safe?
Iodinated contrast media (CM) are used in many investigations that a patient may undergo during the course of an in-patient stay. For the vast majority of patients, exposure to CM has no sequelae; however, in a small percentage, it can result in a worsening in renal function termed contrast-induced acute kidney injury (CI-AKI). CI-AKI is one of the leading causes of in-hospital renal dysfunction. ⋯ Unfortunately, the results of extensive research into pharmacological inventions to prevent CI-AKI remain disappointing. In this article, we briefly outline the pathophysiological mechanisms by which iodinated CM may cause CI-AKI and discuss the evidence for reducing CI-AKI by limiting contrast volumes. In particular, we review the data surrounding the use of contrast volume to glomerular filtration rate ratios, which can be used by clinicians to effectively lower the incidence of CI-AKI in their patients.
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Nephrol. Dial. Transplant. · Jun 2013
Comparative StudyComparison of absolute serum creatinine changes versus Kidney Disease: Improving Global Outcomes consensus definitions for characterizing stages of acute kidney injury.
The Kidney Disease: Improving Global Outcomes (KDIGO) system for classification of acute kidney injury (AKI) severity utilizes a staging schema based on relative changes in serum creatinine (sCr) concentration and urine output. This study compares the in-hospital mortality associated with KDIGO-defined AKI stages and AKI stages defined by absolute sCr increases ('Delta-Creatinine'). ⋯ The Delta-Creatinine system, based on the absolute increases in sCr, provides a promising alternative to the KDIGO system for characterizing the severity of AKI and its associations with in-patient mortality.
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Nephrol. Dial. Transplant. · Jun 2013
Contrast-induced acute kidney injury following coronary angiography: a cohort study of hospitalized patients with or without chronic kidney disease.
Contrast-induced acute kidney injury (CIAKI) has been linked to unfavorable consequences. In routine clinical practice, small increases in serum creatinine (SCr) following coronary angiography tend to be underestimated, especially in patients without chronic kidney disease (CKD). ⋯ CIAKI following coronary angiography was associated with adverse in-hospital and long-term outcomes in both CKD and non-CKD patients.