EMJ Nephrology最新文献

{"title":"Alteration of Glycaemic Balance due to Chronic Kidney Disease","authors":"E. Mácsai","doi":"10.33590/emjnephrol/10313615","DOIUrl":"https://doi.org/10.33590/emjnephrol/10313615","url":null,"abstract":"The incidence of diabetes in patient populations requiring dialysis is constantly increasing. Metabolic disturbances in this group need focussed attention, particularly as carbohydrate balance is affected by specific disease-related factors. Beta-cell dysfunction, insulin resistance, and advanced glycation end-product accumulation are increasingly detected in the period preceding dialysis. Glycaemic control is also linked to the health of bone metabolism and control of renal failure-related anaemia. Novel opportunities in the assessment of glucose homeostasis, including continuous glucose monitoring systems, skin autofluorescence, and investigation of the metabolome, have resulted in significant developments in diagnostics and therapy. Regarding antidiabetic control, the major therapeutic goal for patients on haemodialysis (HD) is the alleviation of glycaemic fluctuation during the post-dialytic phase. The periodicity in antidiabetic regimes on HD and non-HD days is the preferable tool. For patients on peritoneal dialysis, the adverse impact of glucose originated from the standard solutions should be counterbalanced. This review focusses on the relationship between diabetes and HD or peritoneal dialysis and provides clinical suggestions to support the planning of individualised therapy. Nowadays, the number of patients with advanced renal failure is increasing. In current medical training, nephrological and diabetic education is separated within the internal curriculum. Thus, an average nephrologist is not trained in diabetic issues that would enable them to control the carbohydrate metabolism of a patient with renal insufficiency at different stages of glomerular filtration rate narrowing, and additionally is not permitted to change the choice of therapy. Conversely, a general diabetologist is not aware of the effects of kidney failure and dialysis on glycaemic control and is not familiar with the technological details of renal replacement therapies: special alterations related to nephrological factors are therefore not taken into account when treating diabetic patients with kidney disease. The article deals with the theoretical and practical issues of this clinical border area, helping the clinician to choose individual treatment for a particular patient. Guidelines for choice of oral and insulin therapy in this patient group, based on clinical experiences and theoretical considerations, are under continuous development, and definitive results are expected in the near future.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123980855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal Regeneration: Stem Cell-Based Therapies to Battle Kidney Disease","authors":"Takuya Matsumoto, Olivier J M Schäffers, Wenqing Yin, Ryuji Morizane","doi":"10.33590/emjnephrol/10311868","DOIUrl":"https://doi.org/10.33590/emjnephrol/10311868","url":null,"abstract":"While the worldwide prevalence of kidney disease is increasing rapidly, the current therapeutic repertoire for these patients is often limited to dialysis and organ transplantation. However, advances in developmental and stem cell biology have highlighted the potential of stem cells for the development of novel renal regeneration therapies. While there are currently no approved stem cell-based treatments for kidney disease, various types of stem cells have been shown to facilitate regeneration of kidney tissue in preclinical models of both acute and chronic kidney injury. This review summarises the current status of stem cell-based therapies to battle kidney disease. In addition, future directions for the clinical translation of stem cell research towards development of novel renal regeneration therapies are discussed.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"9 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131255451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventions for Preventing Infectious Complications in Haemodialysis Patients with Central Venous Catheters","authors":"C. Caetano, Trycia V Bueloni, D. Ponce","doi":"10.33590/emjnephrol/10313896","DOIUrl":"https://doi.org/10.33590/emjnephrol/10313896","url":null,"abstract":"Vascular access is the main risk factor for bacteraemia, hospitalisation, and mortality among haemodialysis (HD) patients. The type of vascular access most associated with bloodstream infection is central venous catheter (CVC). The incidence of catheter-related bacteraemia ranges between 0.50 and 6.18 episodes per 1,000 catheter days and increases linearly with the duration of catheter use. Given the high prevalence of CVC use and its direct association with catheter-related bacteraemia, which adversely impacts morbidity and mortality rates and costs among HD patients, several prevention measures aimed at reducing the rates of CVC-related infections have been proposed and implemented. As a result, many clinical trials, systematic reviews, and meta-analyses have been conducted to assess the effectiveness, clinical applicability, and long-term adverse effects of such measures. An integrative review was conducted on prophylactic measures against CVC-related infections in HD patients, identifying their potential advantages and limitations. A literature search was performed within multiple databases and meta-analyses on clinical experience with prophylactic antimicrobial therapy in HD CVC were reviewed and appraised.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128078009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dengue-Associated Acute Kidney Infection: An Updated and Comprehensive Qualitative Review of Literature","authors":"Christopher Thiam Seong Lim, Kar Wah Fuah, Sut Enn Lee, Kogula Krishnan Kaniappan, Ru Fah Then","doi":"10.33590/emjnephrol/10313870","DOIUrl":"https://doi.org/10.33590/emjnephrol/10313870","url":null,"abstract":"Dengue is a viral infection transmitted by an Aedes aegypti mosquito bite that poses a major threat to public health worldwide. While acute kidney injury secondary to dengue infection is a potentially lethal complication, it remains one of the least studied complications of dengue fever. The underlying mechanism of dengue-associated acute kidney injury is complex because it involves multiple pathways that could independently lead to its occurrence. Therefore, the cornerstone of dengue-associated acute kidney injury management should involve prompt recognition and identification of the at-risk population and administration of appropriate supportive treatment in a timely manner with the aim of preventing both renal and non-renal morbidity and mortality.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115188967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NephMadness: Lessons from Seven Years on the Leading Edge of Social Media Medical Education","authors":"J. Topf, A. Burgner, Samira S. Farouk, Timothy T Yau, M. Sparks","doi":"10.33590/emjnephrol/10311416","DOIUrl":"https://doi.org/10.33590/emjnephrol/10311416","url":null,"abstract":"","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115228170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New Aspects of Fibrillary and Immunotactoid Glomerulonephritis","authors":"M. Salvadori, A. Tsalouchos","doi":"10.33590/emjnephrol/10314741","DOIUrl":"https://doi.org/10.33590/emjnephrol/10314741","url":null,"abstract":"Renal diseases involving glomerular deposits of fibrillary material are an important diagnostic challenge for an ultrastructural pathologist. Several renal diseases are characterised by the presence of fibrillary material in the glomeruli. Two disorders of this type, termed ‘fibrillary glomerulonephritis’ (characterised by fibrils measuring approximately 20 nm in diameter) and ‘immunotactoid glomerulonephritis’ (characterised by larger, microtubular deposits), have been described. The possible relatedness of these two disorders and their potential association with other systemic illnesses are the subjects of current debate. Other multisystemic diseases, including amyloidosis and various forms of cryoglobulinaemia, can also present with fibrillary or microtubular deposits in the kidney.\u0000\u0000The distinction between fibrillary glomerulonephritis, immunotactoid glomerulonephritis, and other processes that have similar ultrastructural features are discussed in this review. Recently, both in fibrillary glomerulonephritis and in immunotactoid glomerulonephritis, the presence of a DnaJ homolog subfamily member 9 has been detected. This antigen is not present in amyloidosis and could be involved in the pathogenesis of these diseases. This review will discuss the role and the relevance of this antigen.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125113593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival After End-Stage Renal Failure: Preventing Cardiac Death in End-Stage Renal Disease Patients","authors":"J. Gautier, Kristine M. Kubisiak, E. Weinhandl","doi":"10.33590/emjnephrol/10312529","DOIUrl":"https://doi.org/10.33590/emjnephrol/10312529","url":null,"abstract":"At the 56th European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Congress, held in June 2019 in Budapest, Hungary, physicians from the USA, UK, and Spain presented an educational symposium entitled ‘Survival After End-Stage Renal Failure: Preventing Cardiac Death in End-Stage Renal Disease Patients.’ During this symposium, physicians discussed concepts underlying dialysis as a chronic cardiovascular disease state; cardiovascular disease challenges with volume overload, hypertension, and heart failure; the challenge of fluid management in intermittent haemodialysis; and the effect of more frequent therapy on volume and symptom control. This review summarises the symposium.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122449429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Kidney Injury in the Critically Ill Still Remains a Challenge","authors":"K. Janssen van Doorn","doi":"10.33590/emjnephrol/10310689","DOIUrl":"https://doi.org/10.33590/emjnephrol/10310689","url":null,"abstract":"Acute kidney injury (AKI) is a common complication of critical illness and is associated with high morbidity and mortality. The epidemiology and pathogenesis of AKI and changes in renal function and preventive strategies are areas of interest. Although the aetiology of AKI is often multifactorial, sepsis has been consistently found to be a leading contributing factor in AKI during critical illness. Despite revised guidelines and better haemodynamic management, the outcome of AKI is still a reason for concern. Critically ill patients with AKI have significantly improved short-time prognosis with current treatment standards but are more prone to develop increased morbidity in the near future.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114627891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prolonged Intravenous Colistin Use Associated with Acquired Bartter-Like Syndrome in an Adult Patient: A Case Report","authors":"Tatvam T Choksi, Syed Shah","doi":"10.33590/emjnephrol/10312410","DOIUrl":"https://doi.org/10.33590/emjnephrol/10312410","url":null,"abstract":"Colistin-induced nephrotoxicity has widely been identified through the elevation of serum creatinine level or a reduction of glomerular filtration rate, but tubulopathy associated with colistin use is poorly understood. Herein, the authors describe a unique case of a 32-year-old quadriplegic male who developed persistent hypomagnesaemia, hypokalaemia, and metabolic alkalosis >4 weeks into therapy with intravenous colistimethate sodium for the treatment of decubitus sacral osteomyelitis by extensively drug-resistant Klebsiella pneumoniae. This required daily aggressive intravenous repletion of electrolytes and fluids while on the treatment, but it was only after 6 days of finishing the treatment with the antibiotic that metabolic changes resembling acquired Bartter-like syndrome started resolving.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122041117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mycophenolate Mofetil-Induced Colitis with Graft Versus Host Disease-Like Features in a Renal Transplant Recipient: Case Report and Literature Review","authors":"J. Gameiro, N. Rodrigues, M. J. Melo, J. Gonçalves, A. Santana, J. Guerra","doi":"10.33590/emjnephrol/10310061","DOIUrl":"https://doi.org/10.33590/emjnephrol/10310061","url":null,"abstract":"Diarrhoea is a common complication after renal transplant and has a significant impact on quality of life, graft function, and mortality. The main causes of post-transplant diarrhoea are infectious and pharmacological. Mycophenolate mofetil (MMF) is an immunosuppressive medication widely used in kidney transplantation patients. Gastrointestinal side effects of MMF, such as nausea, vomiting, diarrhoea, and abdominal pain, mostly occur during the first months of treatment; however, late-onset diarrhoea does not exclude the diagnosis of MMF-induced colitis. MMF-induced colitis is associated with a wide histological spectrum, including inflammatory bowel disease-like, graft versus host disease-like, and ischaemia-like changes, which may lead to misdiagnosis. The complexity and severity of histological features might explain the variation in treatment response. Given the differences in the therapeutic management and prognosis of these histological changes, it is crucial to consider the diagnosis of MMF-induced colitis. The aim of this paper is to report a rare case of late-onset MMF-induced colitis with graft versus host disease-like features in a renal transplant patient who did not respond to MMF therapy withdrawal, and provide a review of data on this rare complication of immunosuppression.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128664844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}