Journal of nephrology
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Hydroelectrolytic equilibrium alteration in dialysis patients before dialytic treatment consists in extracellular volume expansion and hyperkalemia. Extracellular volume expansion is due to salt and water retention. Because of the self-regulation phenomenon of cell volume, it is made prevalently at the expense of extracellular volume. ⋯ In the uremic patient the retention of nitrogenous catabolites causes the slowing- down in ATP production in Krebs' cycle because of prevalent use of this low -efficiency energetic substrate; ATP supply to Na+/K+ pump, which is ATP-asi- dependent, is reduced and consequently so is pump activity. Thanks to nitrogenous catabolite removal, dialysis recovers the use of other major efficiency energetic substrates, such as carbohydrates and lipids, in Krebs' cycle with an increase of ATP production rate and pump activity. This hypothesis could explain the REMP reduction in end-stage uremia and its correction with dialysis.
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Journal of nephrology · Mar 2001
Practice Guideline GuidelineBioethics in nephrology: guidelines for decision-making in Italy.
In 1998, the Italian Ministry of Health urged the Italian Society of Nephrology (SIN) to draft recommendations for uniform decision-making procedures in the field of dialysis. In accordance with the Ministry's specifications, at the time the Society approved diagnostic protocols regarding clinical questions, but without fully recognizing the multiple issues arising in complex medical situations where dialysis is likely to go on for a long time. The authors propose some guidelines for ethical conduct and their application, with special regard to medico-legal dilemmas, together with the principles of clinical guidelines that would further improve the "perceived quality" of chronic dialytic treatment.
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Journal of nephrology · Mar 2000
Case ReportsBilateral emphysematous pyelonephritis with perirenal abscess cured by conservative therapy.
Emphysematous pyelonephritis is a rare life-threatening infection of the renal parenchyma. It usually affects unilateral kidney and occurs mostly in diabetic patients. It is characterized by the presence of gas within the renal parenchyma and requires prompt diagnosis and early aggressive therapy. ⋯ We describe a case of a 62-year-old diabetic woman who presented with nonketotic hyperosmolar coma and bilateral emphysematous pyelonephritis caused by Klebsiella pneumoniae. Diagnosis of bilateral emphysematous pyelonephritis was confirmed by an abdominal computed tomographic scan and microbiologic studies. Our patient was successfully treated using percutaneous catheter drainage and long-term antibiotic therapy.
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Evidence-based medicine (EBM) combines clinical experience with the best available patient-centred medical knowledge. EBM is not restricted to randomised trials and meta-analyses. ⋯ Interest in this approach is growing fast. The EB Nephrology Section of the Journal of Nephrology aims to help readers to update and extend their knowledge of the foundations, the tools and the products of EBM, with specific applications in the field of clinical nephrology.