Journal of the American Society of Nephrology : JASN
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J. Am. Soc. Nephrol. · Sep 2007
ReviewIs there a shared pathophysiology for thrombotic thrombocytopenic purpura and hemolytic-uremic syndrome?
Thrombotic microangiopathy is characterized by microvascular thrombosis coupled with thrombocytopenia, hemolytic anemia, and red blood cell fragmentation. Familiar to nephrologists and hematologists alike, classically associated with thrombotic microangiopathy are the hemolytic-uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP), the histories and presentations of which are closely intertwined. Not surprising, these two disorders are considered by many to be manifestations of the same disease process, whereas others consider HUS and TTP to be distinct clinical and pathologic entities. Herein are reviewed HUS and TTP along with recent progress shedding new light on possible shared pathophysiologic mechanisms for these two intriguing disorders.
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J. Am. Soc. Nephrol. · Sep 2007
ReviewUse of the DeltaAG/DeltaHCO3- ratio in the diagnosis of mixed acid-base disorders.
When a strong acid is added to plasma, one expects a quantitative relationship between excess anion gap (DeltaAG) and bicarbonate deficit (DeltaHCO(3)(-)) with the DeltaAG/DeltaHCO(3)(-) ratio close to unity. If true, then this ratio could be used to diagnose mixed acid-base disorders in patients with metabolic acidosis. Although the mean ratio in selected patients is close to unity, this ratio also has a wide range, making its use in individual patients problematic. The ratio should therefore be used cautiously in making a diagnosis of mixed acid-base disorders.
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J. Am. Soc. Nephrol. · Sep 2007
Access to kidney transplantation among patients insured by the United States Department of Veterans Affairs.
Ensuring equal access to kidney transplantation is of paramount importance. Veterans that receive care from the Department of Veteran Affairs (VA) must complete a complex process to be placed on the transplant wait-list, and only four VA hospitals in the United States transplant kidneys. This unique system may cause VA patients to wait longer for kidney transplants than other patients. ⋯ Most of this difference was explained by the fact that VA patients were less likely to be placed on the wait-list (HR 0.71; 95% CI 0.67 to 0.76), but even listed VA patients received transplants less frequently than those insured privately (HR 0.89; 95% CI 0.82 to 0.96). Interestingly, VA patients with supplemental private insurance had the same likelihood of transplantation as non-VA patients with private insurance. We conclude that VA-insured patients are less likely to receive transplants than privately insured patients, and that further studies are needed to identify the reasons for this disparity.