Vandewiele B.,Renal Unit |
Vandecasteele S.J.,Renal Unit |
Vanwalleghem L.,AZ Sint Jan |
De Vriese A.S.,Renal Unit
Chest | Year: 2010
Pulmonary toxicity is a known complication of the proliferation signal inhibitor (PSI) sirolimus and consists of diverse entities such as interstitial pneumonitis, lymphocytic alveolitis, bronchiolitis obliterans with organizing pneumonia, and diffuse alveolar hemorrhage. Several cases of interstitial pneumonitis have also been reported with the more recently developed PSI everolimus. In this report, a case of diffuse alveolar hemorrhage attributed to everolimus is described. The patient presented with respiratory symptoms of insidious onset, ultimately resulting in severe respiratory failure characterized by high lactate dehydrogenase levels, patchy groundglass infiltrates, and bloody BAL fluid with predominance of iron-loaded macrophages and monocytes. Withdrawal of the offending drug and temporary association of high-dose steroids resulted in a rapid recovery. Given that prompt drug discontinuation is potentially life saving, PSI-induced pulmonary toxicity should be considered in the differential diagnosis of patients treated with PSIs and presenting with respiratory symptoms or pulmonary lesions. © 2010 American College of Chest Physicians.
Sinico R.A.,Clinical Immunology Unit and Renal Unit |
Di Toma L.,Renal Unit |
Radice A.,Microbiology Institute
Autoimmunity Reviews | Year: 2013
Renal involvement is a common and often severe complication of anti-neutrophil cytoplasmic autoantibody (ANCA) associated vasculitides (AAV).With the exception of Churg-Strauss syndrome (CSS), where kidney involvement is not a prominent feature, renal disease is present in about 70% of patients with Wegener's granulomatosis, now called granulomatosis with polyangiitis (GPA) and in almost 100% of patients with microscopic polyangiitis (MPA). Kidney involvement is generally characterized by a pauci-immune necrotizing and crescentic glomerulonephritis with a very rapid decline of renal function (rapidly progressive glomerulonephritis). Even though there are not qualitative differences in glomerular lesions in patients with GPA or with MPA, chronic damage is significantly higher in MPA (and/or P-ANCA positive patients) than in GPA (and/or C-ANCA positive patients). If untreated necrotizing and crescentic glomerulonephritis has an unfavorable course leading in a few weeks or months to end stage renal disease. Serum creatinine at diagnosis, sclerotic lesions and the number of normal glomeruli at kidney biopsy are the best predictors of renal outcome. Corticosteroids and cyclophosphamide (with the addition of plasma exchange in the most severe cases) are the cornerstone of induction treatment of ANCA-associated renal vasculitis, followed by azathioprine for maintenance. Rituximab is as effective as cyclophosphamide in inducing remission in AAV and probably superior to cyclophosphamide in patients with severe flare, and could be preferred in younger patients in order to preserve fertility and in patients with serious relapses. © 2012 Elsevier B.V.
Chapagain A.,Renal Unit |
Dobbie H.,Renal Unit |
Sheaff M.,Barts and the London NHS Trust |
Yaqoob M.M.,Renal Unit
Kidney International | Year: 2011
Insidious Mycobacterium tuberculosis infection causing tubulointerstitial nephritis is a rare disorder. Here we report on a single-center case series of patients with tubulointerstitial nephritis due to tuberculosis, addressing clinicopathologic features and treatment outcome. Twenty-five adult patients with clinical evidence of tuberculosis and significant renal disease were assessed, 17 of whom had a kidney biopsy and were subsequently diagnosed with chronic granulomatous tubulointerstitial nephritis as the primary lesion. All patients were given standard antitubercular treatment, with some receiving corticosteroids, and showed a good response in clinical symptoms and inflammatory markers. Nine of the 25 patients, however, started renal replacement therapy within 6 months of presentation. Of the remaining 16, renal function improved for up to a year after presentation but subsequently declined through a median follow-up of 36 months. This case series supports that chronic tubulointerstitial nephritis is the most frequent kidney biopsy finding in patients with renal involvement from tuberculosis. Thus, a kidney biopsy should be considered in the clinical evaluation of kidney dysfunction with tuberculosis since tubulointerstitial nephritis presents late with advanced disease. A low threshold of suspicion in high-risk populations might lead to earlier diagnosis and treatment, preserving renal function and delaying initiation of renal replacement therapy. © 2011 International Society of Nephrology.
Impact of glomerular filtration estimate on bleeding risk in very old patients treated with vitamin k antagonists: Results of epica study on the behalf of FCSA (italian federation of anticoagulation clinics)
Poli D.,AOU Careggi |
Antonucci E.,University of Florence |
Zanazzi M.,Renal Unit |
Grifoni E.,University of Florence |
And 3 more authors.
Thrombosis and Haemostasis | Year: 2012
Vitamin K antagonists (VKA) therapy is increasingly used in elderly for prevention of venous thromboembolism (VTE) and of stroke in atrial fibrillation (AF). Glomerular filtration rate (GFR), usually estimated from different equations, decreases progressively with age and it is a risk factor for bleeding. In the frame of the EPICA study, a multicentre prospective observational study including 4,093 patients ≥80 years naïve to VKA treated for AF or after VTE, we performed this ancillary study to evaluate the prevalence of chronic kidney diseases (CKD) by estimated GFR (eGFR). Incidence of bleedings was recorded and bleeding risk was evaluated in relation to eGFR calculated by Cockroft-Gault (C-G); Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas. In addition, the agreement among the three eGFR formulas was evaluated. We recorded 179 major bleedings (rate 1.87 x100 patient-years [py]), 26 fatal (rate 0.27 x100 py). Moderate CKD was detected in 69.3%, 59.3% and 47.0% and severe CKD in 5.8%, 7.4% and 10.0% of cases by C-G, MDRD and CKD-EPI, respectively. Bleeding risk was higher in patients with severe CKD irrespective of the applied equation. This study confirms that CKD represents an independent risk factor for bleeding and that a wide proportion of elderly on VKA had severe or moderate CKD, suggesting the need for frequent monitoring. Although the different available equations yield different eGFR, all appear to similarly predict the risk of major bleeding. © Schattauer 2012.
De Vriese A.S.,Renal Unit |
Vandecasteele S.J.,Renal Unit |
Van Den Bergh B.,Renal Unit |
De Geeter F.W.,AZ Sint Jan Bruges Oostende AV
Kidney International | Year: 2012
The hemodialysis population is characterized by a high prevalence of asymptomatic coronary artery disease (CAD), which should be interpreted differently from asymptomatic disease in the general population. A hemodynamically significant stenosis may not become clinically apparent owing to impaired exercise tolerance and autonomic neuropathy. The continuous presence of silent ischemia may cause heart failure, arrhythmias, and sudden death. Whether revascularization of an asymptomatic dialysis patient improves outcome remains a moot point, although several observational studies and one small RCT suggest a benefit. It can therefore be defended to screen asymptomatic dialysis patients for CAD. A number of noninvasive screening tests are available, but none has proved equally practical and reliable in the dialysis population as in the general population. Myocardial perfusion scintigraphy (MPS) before and after a pharmacological stress such as dipyridamole can reveal both ischemia and myocardial scarring. When compared with coronary angiography, low sensitivities were reported and attributed to impaired vasodilation to dipyridamole in dialysis patients. A more likely explanation is that not every anatomical stenosis will lead to impaired coronary blood flow on MPS. Numerous studies have shown an incremental prognostic value of dipyridamole-MPS over clinical data for prediction of adverse cardiac events, in some studies even over coronary angiography. Pending the availability of high-quality evidence, in our opinion asymptomatic dialysis patients could undergo dipyridamole-MPS, followed by coronary angiography in case of an abnormal scan. This combined physiological and anatomical evaluation of the coronary circulation allows us to determine which coronary stenosis is clinically relevant and therefore should be revascularized. © 2012 International Society of Nephrology.
Vaux E.,Renal Unit |
King J.,Renal Unit |
Lloyd S.,Renal Unit |
Moore J.,Renal Unit |
And 3 more authors.
American Journal of Kidney Diseases | Year: 2013
Background: Quality improvement strategies to increase and maintain the numbers of arteriovenous fistulas (AVFs) are a critical drive in enhancing the quality of care of patients receiving treatment with hemodialysis. How the AVF is needled is an important consideration in AVF survival; the ideal cannulation technique has not been established to date. Study Design: Prospective randomized single-center trial. Setting & Participants: Patients on maintenance hemodialysis therapy (N = 140). Intervention: A 1-year intervention of buttonhole (constant site) or usual-practice (different site) cannulation. Outcomes: Primary study outcome was AVF survival over 1 year, in which AVF failure was defined as an AVF no longer used for hemodialysis (also referred to as assisted patency). Secondary outcomes included primary patency, number of access interventions, bleeding time, infection rate, cannulation time and pain, and aneurysm formation. Results: Demographic data were similar for both groups. The primary outcome measure of AVF survival at 1 year was statistically significantly increased in the buttonhole group (100% vs 86% with usual practice; P = 0.005, log-rank test). In the buttonhole group, there were fewer interventions (19% vs 39% in usual practice) and less existing aneurysm enlargement (23% vs 67% in usual practice). There were no bacteremia events in the buttonhole group and 2 in the usual-practice group (0.09/1,000 AVF days). There were no significant differences in bleeding times and lignocaine use between the 2 groups. Limitations: A single-center study, lack of blinding. Conclusions: In this study, AVF survival was significantly greater when using buttonhole cannulation. The buttonhole technique significantly decreased the need for access interventions and reduced existing aneurysm enlargement. Concerns of increased infection rates or prolonged bleeding times with the buttonhole technique were not seen in this study. The buttonhole technique should be considered the cannulation technique of choice for AVFs. © 2013 National Kidney Foundation, Inc.
Shih L.C.,Renal Unit
Nursing praxis in New Zealand inc | Year: 2011
Compared to non-Māori, New Zealand Māori are at a higher risk of kidney disease which can lead to End Stage Renal Disease (ESRD) and the consequent need for renal replacement therapy, including dialysis, to sustain life. This study was designed to explore the impact that dialysis has on Māori and their whānau/families. An interpretive approach was used. The purposive sample consisted of seven Māori clients having dialysis as outpatients while living in a rural area of Northland. Clients and their whānau/families were interviewed in 2008. A number of themes summarising client perspectives were indentified from analysis of the responses. Despite their differing journeys to the point of requiring haemodialysis four basic themes were revealed: facing their fear; stress from having haemodialysis; learning, adjusting and changing their attitude; and individual needs. Understanding Māori clients' experience of haemodialysis provides insight regarding their requirements, most notably in terms of education and support. Recommendations from this study include the need for early referral and effective education to promote self-management - factors which, in turn, can influence quality of life and lead to more cost effective health care.
Daly C.,Renal Unit
The Cochrane database of systematic reviews | Year: 2014
Peritonitis is the most frequent serious complication of continuous ambulatory peritoneal dialysis (CAPD). It has a major influence on the number of patients switching from CAPD to haemodialysis and has probably restricted the wider acceptance and uptake of CAPD as an alternative mode of dialysis.This is an update of a review first published in 2000. This systematic review sought to determine if modifications of the transfer set (Y-set or double bag systems) used in CAPD exchanges are associated with a reduction in peritonitis and an improvement in other relevant outcomes. We searched the Cochrane Renal Group's Specialised Register through contact with the Trials Search Co-ordinator. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE and EMBASE. Date of last search: 22 October 2013. Randomised controlled trials (RCTs) or quasi-RCTs comparing double bag, Y-set and standard peritoneal dialysis (PD) exchange systems in patients with end-stage kidney disease. Data were abstracted by a single investigator onto a standard form and analysed by Review Manager. Analysis was by a random effects model and results were expressed as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI). Twelve eligible trials with a total of 991 randomised patients were identified. Despite the large total number of patients, few trials covered the same interventions, small numbers of patients were enrolled in each trial and the methodological quality was suboptimal. Y-set and twin-bag systems were superior to conventional spike systems (7 trials, 485 patients, RR 0.64, 95% CI 0.53 to 0.77) in preventing peritonitis in PD. Disconnect systems should be the preferred exchange systems in CAPD.
Blinkhorn T.M.,Renal Unit |
Blinkhorn T.M.,Womens Hospital
Renal Society of Australasia Journal | Year: 2012
Background: Worldwide 80% of health care costs are being consumed by people with chronic disease. In Australia, chronic kidney disease (CKD) is estimated to cost $1 billion. With tighter fiscal control and a constantly expanding CKD population, multiple strategies are being investigated to provide more efficient models of care. Telehealth is one strategy which could provide significant efficiencies in relation to improved care, better disease management and reduced overall costs. Aim: To examine the peer-reviewed primary research exploring the use of telehealth in the context of renal health care. Method: The databases EBSCO (CINAHL, OVID and PRO REQUEST) and PubMed were searched for all research articles published in English from January 2000 to January 2012. Inclusion criteria were research findings and published in English. Exclusion criteria were discussion papers and literature reviews. Results: Ten articles met the inclusion criteria involving 3032 patients and four health care providers. Of those studies, eight were quantitative studies, one used qualitative methods and one adopted mixed methods. All of the research originated in North America and Europe. Renal health has used four types of telehealth: teleconferences, teleconsultation, telemonitoring and teledialysis. Telehealth applications have been successful in the remote care of CKD patients, in terms of patient outcomes and satisfaction. Conclusion: Telehealth applications based on information and communications technologies (ICT) are currently being successfully used throughout the world to treat and manage the care of CKD patients. Compared to other chronic disease specialities, the development of telehealth applications within the renal setting appears underutilised and under-researched. Copyright © 2013 Renal Society of Australasia.
Ulasi I.I.,Renal Unit |
Ijoma C.K.,Renal Unit
Journal of Tropical Medicine | Year: 2010
Background. The magnitude of the problem of chronic kidney disease (CKD) is enormous, and the prevalence keeps rising. To highlight the burden of CKD in developing countries, the authors looked at end-stage renal disease (ESRD) patients seen at the University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria. Method. ESRD patients seen from 01/05/1990 to 31/12/2003 were recruited. Records from A&E Department, medical-out-patients, wards and dialysis unit were used. Results. A total of 1001 male versus 537 female patients were reviewed. About 593 male versus 315 female patients had haemodialysis. The mean age was 42.55 ± 15.43 years and 86.5 were 60 years. Primary renal disease could not be determined in 51.6 while hypertension and glomerulonephritis accounted for -17.2 and 14.6, respectively. Death from renal causes constituted 22.03 of medical deaths. Conclusion. The prognosis for CKD patients in Nigeria is abysmal. Only few patients had renal-replacement- therapy (RRT). The prohibitive cost precludes many patients. This underscores the need for preventive measures to reduce the impact of CKD in the society. Copyright © 2010 I. I. Ulasi and C. K. Ijoma.