scholarly journals The complex interplay between kidney injury and inflammation

2020 ◽  
Author(s):  
Stephen J McWilliam ◽  
Rachael D Wright ◽  
Gavin I Welsh ◽  
Jack Tuffin ◽  
Kelly L Budge ◽  
...  
Keyword(s):  
Disease Process ◽  
Kidney Injury ◽  
Underlying Disease ◽  
Acute Glomerulonephritis ◽  
Renal Inflammation ◽  
Increased Risk ◽  
Repair Mechanisms ◽  
Nephron Loss ◽  
Strong Inflammatory Response ◽  
Personalized Approach

Abstract Acute kidney injury (AKI) has gained significant attention following patient safety alerts about the increased risk of harm to patients, including increased mortality and hospitalization. Common causes of AKI include hypovolaemia, nephrotoxic medications, ischaemia and acute glomerulonephritis, although in reality it may be undetermined or multifactorial. A period of inflammation either as a contributor to the kidney injury or resulting from the injury is almost universally seen. This article was compiled following a workshop exploring the interplay between injury and inflammation. AKI is characterized by some degree of renal cell death through either apoptosis or necrosis, together with a strong inflammatory response. Studies interrogating the resolution of renal inflammation identify a whole range of molecules that are upregulated and confirm that the kidneys are able to intrinsically regenerate after an episode of AKI, provided the threshold of damage is not too high. Kidneys are unable to generate new nephrons, and dysfunctional or repeated episodes will lead to further nephron loss that is ultimately associated with the development of renal fibrosis and chronic kidney disease (CKD). The AKI to CKD transition is a complex process mainly facilitated by maladaptive repair mechanisms. Early biomarkers mapping out this process would allow a personalized approach to identifying patients with AKI who are at high risk of developing fibrosis and subsequent CKD. This review article highlights this process and explains how laboratory models of renal inflammation and injury assist with understanding the underlying disease process and allow interrogation of medications aimed at targeting the mechanistic interplay.

Human Immunodeficiency Virus-Associated Thrombocytopenia

DICP ◽  
1989 ◽  
Vol 23 (2) ◽  
pp. 157-160 ◽  
Author(s):  
Dennis M. Hoffman ◽  
Rocco F. Caruso ◽  
Timothy Mirando
Keyword(s):  
Human Immunodeficiency Virus ◽  
Immune Globulin ◽  
Disease Process ◽  
Underlying Disease ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Acquired Immunodeficiency ◽  
A New Technique ◽  
Immunodeficiency Syndrome

Thrombocytopenia has emerged as a major hematological manifestation associated with AIDS (acquired immunodeficiency syndrome) and human immunodeficiency virus (HIV)-positive patients. A study of homosexual patients with thrombocytopenia indicates 93 percent had serological evidence of HIV exposure whereas only 33 percent of homosexuals without thrombocytopenia exhibited this finding. Thrombocytopenia in patients with hemophilia has been identified as an increased risk factor for AIDS development and has been observed in about one-third of children with AIDS. The management of thrombocytopenia in HIV-infected patients poses a therapeutic dilemma for clinicians since many of the traditional modalities for treating immune thrombocytopenia may adversely affect the underlying disease process or further compromise the immune system. Splenectomy, corticosteroids, danazol, intravenous immune globulin, vincristine, and RHo(D) immune globulin have all been used with variable results. A new technique that physically removes antibodies and immune complexes associated with thrombocytopenia is under investigation. Due to either toxicity or the high incidence of transient response, asymptomatic patients may not be candidates for treatment.

scholarly journals Poor Oral Health and Pre-Term Low Birth Infants

1970 ◽  
Vol 37 (2) ◽  
pp. 56-65
Author(s):  
AKM Bashar ◽  
MS Alam
Keyword(s):  
Medical Journal ◽  
Oral Health ◽  
Oral Cavity ◽  
Disease Process ◽  
Underlying Disease ◽  
The Body ◽  
Health Conditions ◽  
Low Birth Weight Infants ◽  
Increased Risk ◽  
The Relationship

Oral health though often considered as a distinct specialty that is separate from the body as a whole, but the health of the oral cavity can have wide-reaching effects on overall health. Poor oral health may occur concomitantly with a more serious underlying disease process or may predispose an individual to other health conditions. This article examines the relationship between poor oral health and increased risk for Pre-term low birth weight infants, underscoring that the oral cavity and its tissues are an integral part of the human body.   DOI: 10.3329/bmj.v37i2.3595 Bangladesh Medical Journal 37(2) 2008 56-65

scholarly journals MON-374 Management of 1,25-dihydroxyvitamin D (1,25-OHD) Mediated Hypercalcemia of Unknown Etiology

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Sruthi Menon ◽  
Swashti Agarwal ◽  
David L Paul
Keyword(s):  
Treatment Options ◽  
Disease Process ◽  
Kidney Injury ◽  
Underlying Disease ◽  
Unknown Etiology ◽  
Repeat Dose ◽  
Diagnostic Dilemma ◽  
Dihydroxyvitamin D ◽  
Severe Hypercalcemia ◽  
25 Hydroxy Vitamin D

Abstract Background: We describe the diagnostic dilemma and treatment challenges faced in a rare case of 1,25-OHD mediated hypercalcemia. Clinical Case: A 13 year old boy was admitted with severe hypercalcemia (calcium 15.5 mg/dl) in the setting of a non-specific rash, malaise, pancytopenia and acute kidney injury. He was incidentally also noted to have hypogammaglobulinemia a few months prior to presentation. Blood tests were suggestive of hypercalcemia mediated by 1,25-OHD (level >200 pg/ml; ref: 30-83 pg/ml). 25-hydroxy vitamin D was normal (29 ng/ml) and PTH was appropriately suppressed (<4 pg/ml). Workup for various etiologies including infectious, rheumatologic and oncologic diseases associated with ectopic production of 1,25-OHD was initiated. Hypercalcemia was initially managed with hyperhydration, furosemide and calcitonin. However after a brief period of improvement in hypercalcemia, levels started to rise again despite increasing calcitonin dose and frequency (secondary to tachyphylaxis). Kidney function also started to worsen. Extrarenal 1-alpha hydroxylase activity can be suppressed using steroid therapy, however it was contraindicated at the time given that malignancy and other infectious etiologies had not been excluded. At that point, a trial of zoledronic acid was done with subsequent resolution of hypercalcemia. However, this was only temporary given that the underlying disease process driving the production of 1,25-OHD had not been addressed. Various other treatment options were considered including a repeat dose of bisphosphonate, denosumab, ketoconazole and hydroxychloroquine, but since hypercalcemia was only mild, supportive measures were continued. An extensive workup revealed splenomegaly, lymphadenopathy, bilateral renomegaly and bilateral pulmonary ground glass opacities and nodules. Infectious workup and bone marrow biopsy were negative. Although non-specific, an elevated angiotensin converting enzyme (ACE) level (359 units/L; ref: 13-100 units/L) suggested an underlying granulomatous process. Renal biopsy showed non-caseating granulomas. The most likely unifying diagnosis was thought to be sarcoidosis, however presence of hypogammaglobinemia also raised suspicion for a granulomatous form of Common Variable Immunodeficiency (CVID) which, albeit rare, has previously been reported to be associated with hypercalcemia. Patient was started on empiric treatment with steroids and intravenous immunoglobulin following which calcium, 1,25-OHD and ACE levels normalized. Conclusion: Granulomatous form of CVID is a rare entity but should be considered in a patient presenting with 1,25-OHD mediated hypercalcemia and hypogammaglobulinemia. Treatment of this entity during an ongoing diagnostic workup can be challenging, particularly if the use of steroids is contraindicated due to potential interference with diagnostic investigations.

Drug-Induced Movement Disorders

2015 ◽  
Vol 25 (2) ◽  
pp. 70-77
Author(s):  
Amy Lustig ◽  
Cesar Ruiz
Keyword(s):  
Movement Disorders ◽  
Medical Management ◽  
Disease Process ◽  
Underlying Disease ◽  
Extrapyramidal Symptoms ◽  
Drug Induced ◽  
General Overview ◽  
Management Approaches ◽  
Broad Understanding ◽  
Underlying Disease Process

The purpose of this article is to present a general overview of the features of drug-induced movement disorders (DIMDs) comprised by Parkinsonism and extrapyramidal symptoms. Speech-language pathologists (SLPs) who work with patients presenting with these issues must have a broad understanding of the underlying disease process. This article will provide a brief introduction to the neuropathophysiology of DIMDs, a discussion of the associated symptomatology, the pharmacology implicated in causing DIMDs, and the medical management approaches currently in use.

Prevalence of metabolic syndrome in never treated mood disordered patientss

2007 ◽  
Vol 30 (4) ◽  
pp. 95
Author(s):  
Valerie Taylor ◽  
Glenda M. MacQueen
Keyword(s):  
Metabolic Syndrome ◽  
Mood Disorders ◽  
Population Attributable Risk ◽  
Disease Process ◽  
Visceral Obesity ◽  
Premature Mortality ◽  
Overweight And Obesity ◽  
The Metabolic Syndrome ◽  
Increased Risk ◽  
Bipolar Patients

Bipolar disorder and major depression are life-shortening illnesses. Unnatural causes such as suicide and accidents account for only a portion of this premature mortality1 Research is beginning to identify that mood disordered patients have a higher incidence of metabolic syndrome, an illness characterized by dyslipidemia, impaired glucose tolerance, hypertension and obesity.2 Metabolic syndrome is associated with an increased risk for a variety of physical illnesses. Hypothesis: Never treated patients with mood disorders have preexisting elevations in the prevalence of the component variables of metabolic syndrome. Central obesity will be especially elevated, predicting increased premature mortality. Methods: We assessed never treated patients with mood disorders for metabolic syndrome and its component variables. Patients were assessed at baseline and followed up at 6-month intervals. All psychiatric pharmacotherapy was documented. Body mass index (BMI) was also obtained and the percentage of deaths attributable to overweight and obesity was calculated using the population attributable risk (PAR). [PAR= ∑[P (RR-1)/RR] Results: Prior to the initiation of treatment, patients did not differ from population norms with respect to metabolic syndrome or BMI. At 2-year follow-up, BMI had increased for unipolar patients 2.02 points and 1.92 points for bipolar patients. (p < .001) This increase in BMI predicted an increase in mortality of 19.4%. Conclusion: An increase in visceral obesity is often the first component of metabolic syndrome to appear and may indicate the initiation of this disease process prematurely in this group. The increase in BMI places patients with mood disorders at risk for premature mortality and indicates a need for early intervention. References 1.Osby U, Brandt L, Correia N, Ekbom A & Sparen P. Excess mortability in bipolar and Unipolar disorder rin Sweden. Archives of General Psychiatry, 2001;58: 844-850 2.Toalson P, Saeeduddin A, Hardy T & Kabinoff G. The metabolic syndrome in patients with severe mental illness. Journal of Clinical Psychiatry, 2004; 6(4): 152-158

scholarly journals A Porthole over AKI: Cell Dynamics in Damage and Repair

Nephron ◽  
2020 ◽  
Vol 144 (12) ◽  
pp. 650-654
Author(s):  
Luca Bordoni ◽  
Donato Sardella ◽  
Ina Maria Schiessl
Keyword(s):  
Acute Kidney Injury ◽  
Renal Cell ◽  
Kidney Injury ◽  
Cell Types ◽  
Cell Interactions ◽  
Intravital Imaging ◽  
Cell Dynamics ◽  
Powerful Technique ◽  
Increased Risk ◽  
Cell Crosstalk

Acute kidney injury (AKI) is associated with an increased risk of CKD. Injury-induced multifaceted renal cell-to-cell crosstalk can either lead to successful self-repair or chronic fibrosis and inflammation. In this mini-review, we will discuss critical renal cell types acting as victims or executioners in AKI pathology and introduce intravital imaging as a powerful technique to further dissect these cell-to-cell interactions.

scholarly journals AB0267 HOW EFFECTIVE IS PAIN MANAGEMENT IN THE PATIENTS’ OPINION? DATA FROM THE COMPAS STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1160.1-1160
Author(s):  
E. Pogozheva ◽  
A. Karateev ◽  
V. Amirdzhanova
Keyword(s):  
Pain Management ◽  
Pain Therapy ◽  
Significant Proportion ◽  
Connective Tissue Diseases ◽  
Underlying Disease ◽  
Additional Treatment ◽  
Results Of Treatment ◽  
Analgesic Therapy ◽  
Folk Remedies ◽  
Personalized Approach

Objectives:to evaluate the effectiveness and satisfaction of pain management in patients with rheumatic diseases (RD) according to a survey in the COMPAS (Quality of Pain Management according to Patients with Arthritis and Back pain) study.Methods:the survey involved 1040 patients with RD (rheumatoid arthritis-40.6%, osteoarthritis -32.1%, spondyloarthritis-10.6%, connective tissue diseases-8.6% of patients). 76.8% were women, the mean age was 55.8±14.0 years. 35.7% of patients continued to work in their specialty, 31.6% had various degrees of disability. The effectiveness of pain therapy was evaluated by the patient in the last month preceding the survey on a 5-point scale, where 1 - no effect and 5-excellent effect. Patients ‘ satisfaction with treatment, possible reasons for the lack of effectiveness of pain therapy and the use of additional treatment tools were also evaluated.Results:as therapy for the underlying disease, 40% of patients received conventional disease modifying antirheumatic drugs, 33.1% - glucocorticoids, 7.2% - biological agents and 15.2% - symptomatic slow-acting drugs in osteoarthritis. At the same time, 68% of patients needed additional analgesic therapy with nonsteroidal anti-inflammatory drugs (NSAIDs). Slightly less than half of the surveyed patients (46.9%) noted a moderate effect of analgesic therapy, 22.7% - a low effect and 5% - no effect, 23.7% rated the effectiveness of therapy as good and only 1.7% - as excellent. At the same time, only 15.6% of patients were completely satisfied with the result of NSAIDs, 64% were partially satisfied with the treatment and 20.4% were completely dissatisfied. As the reason of insufficient effectiveness of NSAIDs, most often (34.3%) patients named fear of adverse events associated with taking drugs, 19.4% - weak drugs, 15.3% - insufficient attention of doctors to complaints, 6.6% - poor diagnosis of the causes of pain. Others found it difficult to answer or were completely satisfied with the treatment. 40% of patients used additional methods, most often chiropractic (12.3%), acupuncture (4.8%), physiotherapy (12.7%) and folk remedies (7.4%).Conclusion:A significant proportion of patients with RD don’t have adequate pain control. Only 25.4% of patients rate the result of treatment as good and excellent, and even fewer patients (15.6%) are completely satisfied with the results of therapy. Thus, a personalized approach to analgesic therapy is necessary, taking into account the expectations of patients regarding the results of treatment.Disclosure of Interests:None declared

scholarly journals Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative

2021 ◽  
Author(s):  
John R. Prowle ◽  
Lui G. Forni ◽  
Max Bell ◽  
Michelle S. Chew ◽  
Mark Edwards ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Baseline Risk ◽  
Major Surgery ◽  
Increased Risk

AbstractPostoperative acute kidney injury (PO-AKI) is a common complication of major surgery that is strongly associated with short-term surgical complications and long-term adverse outcomes, including increased risk of chronic kidney disease, cardiovascular events and death. Risk factors for PO-AKI include older age and comorbid diseases such as chronic kidney disease and diabetes mellitus. PO-AKI is best defined as AKI occurring within 7 days of an operative intervention using the Kidney Disease Improving Global Outcomes (KDIGO) definition of AKI; however, additional prognostic information may be gained from detailed clinical assessment and other diagnostic investigations in the form of a focused kidney health assessment (KHA). Prevention of PO-AKI is largely based on identification of high baseline risk, monitoring and reduction of nephrotoxic insults, whereas treatment involves the application of a bundle of interventions to avoid secondary kidney injury and mitigate the severity of AKI. As PO-AKI is strongly associated with long-term adverse outcomes, some form of follow-up KHA is essential; however, the form and location of this will be dictated by the nature and severity of the AKI. In this Consensus Statement, we provide graded recommendations for AKI after non-cardiac surgery and highlight priorities for future research.

Sign in / Sign up

Export Citation Format

Share Document