Journal of nephrology
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Acute kidney injury (AKI), at least in critically ill patients, seldom occurs as isolated organ failure. Much more often it emerges as a component of the multiple organ failure syndrome, within the framework of the severe and prolonged catabolic phase determined by critical illness, and intensified by specific derangements in substrate utilization due to the acute loss of kidney function. On these bases, patients with AKI often have protein-energy wasting (preexisting and/or hospital acquired), which represents a major negative prognostic factor. ⋯ The enteral route should be the preferred route for nutrient delivery; however, parenteral nutrition is often required to target nutritional requirements. Due to the loss of the kidney's homeostatic function, and the frequent need of RRT, patients with AKI are especially prone to complications of nutritional support, such as hyperglycemia, hypertriglyceridemia, fluid retention, electrolyte and acid-base derangements. Since AKI comprises a highly heterogeneous group of subjects with nutrient needs widely varying even along the clinical course in the same patient, nutritional requirements should be frequently reassessed, individualized and carefully integrated with RRT.
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Journal of nephrology · Sep 2008
Case ReportsContinuous renal replacement therapy combined with extracorporeal membrane oxygenation in advanced cardiac failure patients.
Acute renal failure during extracorporeal membrane oxygenation (ECMO) support is associated with extremely high mortality. This report describes treatment of myocardial dysfunction in one 48-year-old and one 11-year-old patient. ⋯ Continuous venovenous hemodialysis was performed for acute renal failure with pulmonary edema and oliguria. Both patients survived following treatment with venoarterial ECMO combined with continuous venovenous hemodialysis.
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Journal of nephrology · Sep 2008
The research to health policy cycle: a tool for better management of chronic noncommunicable diseases.
Effectively responding to the global epidemic of noncommunicable disease will require a new research paradigm that integrates decision-makers into every step of the work. We present a systematic, multidisciplinary, staged research framework that involves setting priorities, designing, pilot testing and implementing novel interventions, and translating the lessons learned for clinicians and other stakeholders. This framework could be used by health services researchers in other areas to increase the likelihood that their research will be incorporated into health policy. Used together with existing administrative data sets, this framework has the potential to create virtual "health policy laboratories" in which novel, cost-effective, equitable and efficacious approaches to improving health are identified and validated.
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Journal of nephrology · Jul 2008
Comparative StudyEffective treatment administration of cyclophosphamide in membranous nephropathy.
Idiopathic membranous nephropathy (IMN) is the most common cause of nephrotic syndrome in adults. In this prospective study, we investigated the efficacy of combined use of oral or pulse cyclophosphamide (CYC) with low-dose steroid on our group of adult IMN patients whose renal function was normal at the time of diagnosis. ⋯ With regard to patients with IMN, the combination of CYC with corticosteroids was beneficial in conserving renal function and in induction of remission of nephrotic syndrome. We observed that pulse CYC treatment significantly increased serum albumin levels when compared with oral CYC.
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Journal of nephrology · May 2008
Randomized Controlled Trial Multicenter Study Comparative StudySupportive Versus Immunosuppressive Therapy of Progressive IgA nephropathy (STOP) IgAN trial: rationale and study protocol.
The best treatment of IgA nephropathy (IgAN) is currently not well defined. The Supportive Versus Immunosuppressive Therapy of Progressive IgA Nephropathy (STOP IgAN) trial aims to answer if, in IgAN patients, an immunosuppressive treatment is more effective than a supportive treatment. ⋯ In a randomized prospective multicenter study (www.clinicaltrials.gov, NCT00554502), we will treat 148 patients at risk for progressive IgA nephropathy following a 6-month run-in phase, in 2 groups: (group a) supportive treatment: patients with a persistent proteinuria >0.75 g/day will receive a maximized therapy to reduce blood pressure and urinary protein loss using angiotensin-converting enzyme inhibitors and AT1 blockers, statins, dietary counseling for a low-sodium and low-protein diet and education/intervention programs to stop smoking. (group b) immunosuppressive treatment: in addition to the identical treatment of group a, patients will receive treatment with steroids (glomerular filtration rate [GFR] > or =60 ml/min) or steroids plus cyclophosphamide/azathioprine (GFR <60 ml/min). Study end points are the complete remission of the disease and the individual degree of renal functional loss. If the immunosuppressive therapy shows a superior efficacy with respect to prevention of renal failure, the potentially higher therapy cost and risk might be justified. Finally, our trial can serve as a model for various other types of glomerulonephritis, for which such trials are very difficult to perform, given their infrequency.