Current opinion in nephrology and hypertension
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Living kidney donors face a unique decision of self-sacrifice that is not without potential risk. The purpose of this review is to highlight existing research regarding the perioperative morbidity, mortality and long-term outcomes of living kidney donors. ⋯ Living kidney donation is a superior transplantation option for many individuals with ESRD. The survival and health consequences of living donation have proven to be excellent. These favorable outcomes stem from careful screening measures, and further research endeavors are needed to ensure long-term living donor safety in high-risk donors.
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Curr. Opin. Nephrol. Hypertens. · May 2011
ReviewProteinuria and reduced glomerular filtration rate as risk factors for acute kidney injury.
Acute kidney injury (AKI) is a major public health concern, and preexisting kidney disease may be one of the most important risk factors. We review recent epidemiologic evidence supporting baseline proteinuria and reduced glomerular filtration rate as risk factors for AKI. ⋯ The presence of baseline proteinuria and reduced baseline eGFR are powerful independent predictors for AKI and should be taken into account in clinical practice to identify high-risk patients for receipt of aggressive preventive measures to reduce risk of AKI.
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Curr. Opin. Nephrol. Hypertens. · Nov 2010
ReviewShould there be an expanded role for palliative care in end-stage renal disease?
In this review, we outline the rationale for expanding the role of palliative care in end-stage renal disease (ESRD), describe the components of a palliative care model, and identify potential barriers in implementation. ⋯ There is a large unmet need to alleviate the physical, psychosocial, and existential suffering of patients with ESRD. More fully integrating palliative care into ESRD management by improving end-of-life care training, eliminating structural and financial barriers to hospice use, and identifying optimal methods to deliver palliative care are necessary if we are to successfully address the needs of an aging ESRD population.
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Curr. Opin. Nephrol. Hypertens. · Nov 2010
ReviewStrategies for the prevention of contrast-induced acute kidney injury.
The intravascular administration of iodinated contrast media for diagnostic imaging is a common cause of acute kidney injury and a leading cause of iatrogenic renal disease. The purpose of this review is to describe the principal risk factors for contrast-induced acute kidney injury and to summarize recent data describing the efficacy of various preventive interventions for this condition. ⋯ Prevention of contrast-induced acute kidney injury involves the identification of high-risk patients, consideration of alternative imaging procedures that do not involve the administration of iodinated contrast, and integration of the cumulative data available on preventive interventions in high-risk patients.
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We review literature from the past 18 months on the treatment of hyponatremia. Therapy must address both the consequences of the untreated electrolyte disturbance (including fatal cerebral edema due to acute water intoxication) and the complications of excessive therapy (the osmotic demyelination syndrome). ⋯ Correction of hyponatremia by 4-6 mEq/l within 6 h, with bolus infusions of 3% saline if necessary, is sufficient to manage the most severe manifestations of hyponatremia. Planning therapy to achieve a 6 mEq/l daily increase in the serum sodium concentration can avoid iatrogenic brain damage by staying well clear of correction rates that are harmful. Conservative correction goals are wise because inadvertent overcorrection is common. Administration of desmopressin to halt a water diuresis can help prevent overcorrection; if overcorrection occurs, therapeutic relowering of the serum sodium concentration is supported by data in experimental animals and was found to be safe in a small observational clinical trial. Even mild and apparently asymptomatic hyponatremia may lead to falls because of impaired gait, and an increased likelihood of fracture because of hyponatremia-induced osteoporosis, a newly described entity. Recently approved vasopressin antagonists now make it possible to normalize the serum sodium concentration on a chronic basis, but practical considerations have limited their use.