Current opinion in nephrology and hypertension
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Curr. Opin. Nephrol. Hypertens. · Jan 2003
ReviewThe role of adhesion molecules and T cells in ischemic renal injury.
The pathophysiology of ischemic acute renal failure is complex, incompletely understood and there are no specific therapies. Descriptive observations in human acute renal failure, as well as mechanistic studies in animals, have demonstrated an important pathophysiological role for leukocytes and leukocyte adhesion molecules. The purpose of this review is to summarize and interpret the recent advances on the role of T cells and leukocyte adhesion molecules in ischemic acute renal failure. ⋯ The identification of T cells and new adhesion molecule pathways as modulators of ischemic acute renal failure offers novel and feasible therapeutic opportunities for both native and transplant acute renal failure. Rigorous clinical trials are required to translate these basic findings to the bedside. In addition, mechanistic studies are needed to elucidate the molecular mechanisms by which these pathways modulate kidney injury. The identification of T cell engagement in ischemic renal injury can also help explain long-standing observations linking alloantigen-independent and alloantigen-dependent renal damage.
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Ischemic injury to the kidney is associated with high morbidity and mortality. Improving the ability of the kidney to tolerate ischemic injury would have important implications. A significant amount of data now exists to suggest that there may be intrinsic mechanisms brought to bear by the kidney when exposed to a toxic or ischemic insult, which protect it against a subsequent exposure to ischemia. ⋯ There is compelling evidence in other organs that preconditioning occurs in humans. It therefore behooves us to understand the endogenous processes that the kidney has developed to protect itself against an ischemic insult. Armed with this understanding we can then attempt to mimic these processes and thereby prevent and treat ischemic acute renal failure.
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Curr. Opin. Nephrol. Hypertens. · Nov 2000
ReviewTreatment of the alcohol intoxications: ethylene glycol, methanol and isopropanol.
Intoxications with ethylene glycol, methanol, and isopropanol are among the most common ingestions, in the treatment of which a nephrologist plays an important role. These three substances have the ideal characteristics for intervention by hemodialysis, and the three parent compounds and their metabolites are readily dialyzable. ⋯ Fomepizole, an inhibitor of alcohol dehydrogenase, slows the metabolism of these substances and is now approved by the US Food and Drug Administration for use in ethylene glycol intoxication. The present review addresses recent advances in the diagnosis and treatment of intoxication with ethylene glycol, methanol and isopropanol.
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Curr. Opin. Nephrol. Hypertens. · Sep 2000
ReviewCrystalloids versus colloids for resuscitation in shock.
The optimal composition of fluid for volume resuscitation in critically ill patients has been the subject of controversy for decades. Clinicians are faced with several options, including crystalloid solutions of varying tonicity, several colloid preparations (albumin and others), and blood products. ⋯ Albumin infusion may be of more value in patients with cirrhosis, or in those at high risk of acute renal failure. Additional randomized trials will be needed to establish the optimal composition and volume of colloid or crystalloid solutions for resuscitation in shock.
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Curr. Opin. Nephrol. Hypertens. · Sep 1998
ReviewRenal aquaporins: key roles in water balance and water balance disorders.
The discovery of a family of molecular water channels, aquaporins, by Agre and co-workers has shed light on the long-standing biophysical question of how water traverses biological membranes, and has provided detailed molecular insight into the fundamental physiology of water balance and the pathophysiology of water balance disorders. In this review, we focus mainly on the vasopressin-regulated water channel, aquaporin 2, and its critical role in acute and chronic regulation of body water balance, as well as in multiple water balance disorders.