scholarly journals Renal Function as a Predictor of Reamputation After Initial Transmetatarsal Amputation in the Perioperative Period

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0001
Author(s):  
Junho Ahn ◽  
Katherine Raspovic ◽  
Dane Wukich ◽  
George Liu
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Failure ◽  
Renal Function ◽  
Kidney Disease ◽  
Lower Extremity ◽  
Perioperative Period ◽  
Improvement Program ◽  
Acs Nsqip ◽  
Cell Counts ◽  
Insulin Dependent

Category: Midfoot/Forefoot Introduction/Purpose: With increasing rates of patients being newly diagnosed with diabetes mellitus, foot complications are becoming more common, which often lead to amputation. Compared to major lower extremity amputations, transmetatarsal amputations (TMA) are associated with lower cost, better function, and more aesthetically satisfactory results for patients. Renal failure has been shown to be a significant predictor of morbidity and mortality in lower extremity amputations at various levels. However, previous reports examining the effect of renal function on reamputation rates after TMA have been mixed. As a result, the purpose of this study was to evaluate renal dysfunction as a risk factor for reamputation after initial TMA during the 30-day perioperative period in a large population database. Methods: Patients under 90 years of age who underwent a TMA between 2012 and 2015 were retrospectively identified in the prospectively collected American College of Surgeons-National Surgical Quality Improvement Program® (ACS-NSQIP®) database using the Current Procedure Terminology (CPT) code 28805. Failure of the initial TMA was defined as reamputation in the 30-day perioperative period through corresponding CPT codes. From these criteria, a total of 1,775 patients were identified. More than 150 unique patient factors were included in the study, but glycated hemoglobin (HbA1C) was not reported by the ACS-NSQIP® database. Diabetes status was categorized into four groups: “Insulin” dependent, “Non-Insulin” dependent, or “None.” Filtration rate was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, and patients were categorized into stages of chronic kidney disease (CKD). Results: Over the 30-day perioperative period, the rate of reamputation after TMA was 6.5%. No statistical differences in age, gender, race, body-mass index, or level of pre-operative functional status were found between groups. Reamputation rates after TMA was significantly correlated with higher white blood cell counts (p<.00001), greater serum creatinine (p=.021), higher blood urea nitrogen (p=.021), type of glycemic control (p=.002), stage of CKD (p=.003), dialysis (p=.001), and pre-operative blood transfusion (p=.042). Stage IV-V CKD was associated with 75% increased odds of reamputation (OR=1.75, 95% CI=1.12-2.73), and higher stage of CKD was associated with greater reamputation rates (p=.003) where stage II CKD had the lowest reamputation rate (3.6%) and stage V with the highest reamputation rate (10.9%). A similar trend was seen with 30-day mortality (p<.00001). Conclusion: In the current study, CKD was significantly correlated with reamputation rates after TMA as well as 30-day mortality. In contrast to a previous report, dialysis was also associated with TMA failure and need for reamputation. Our findings corroborate previous findings correlating dialysis-dependent renal failure and mortality. Whether patients in certain stages of CKD would achieve better outcomes with higher-level amputation rather than a TMA should be investigated in future studies.

scholarly journals Shen Shuai II Recipe Attenuates Renal Interstitial Fibrosis by Improving Hypoxia via the IL-1β/c-Myc Pathway

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Liuyi Yang ◽  
Meng Wang ◽  
Yuan Zhou ◽  
Jing Yang ◽  
Chaoyang Ye ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Failure ◽  
Renal Function ◽  
Chronic Renal Failure ◽  
Kidney Disease ◽  
Protein Expression ◽  
Interstitial Fibrosis ◽  
Renal Interstitial Fibrosis ◽  
Related Factors

Background. Renal interstitial fibrosis is a pathological manifestation of progression of chronic kidney disease induced by various factors. Shen Shuai II Recipe (SSR) has been used in clinical practice for more than 20 years, and clinical studies have confirmed that SSR significantly improves the renal function of patients with chronic kidney disease. However, the specific mechanisms underlying its efficacy require further research. This study aims to explore the influencing factors of renal interstitial fibrosis in the context of hypoxia via the IL-1β/c-Myc pathway and the potential molecular mechanisms of SSR intervention in vivo and in vitro. Methods. A rat model of chronic renal failure was developed by performing 5/6 (ablation/infarction, A/I) surgery on randomly selected, male Sprague Dawley rats. Thirty-six successfully modeled rats were randomly divided into three groups: 5/6 (A/I), 5/6 (A/I) + SSR, and 5/6 (A/I) + losartan. Another 12 rats were used as the sham group. After 8 weeks of the corresponding intervention, renal function, liver function, and protein expression of renal-fibrosis-related factors, HIF-1α, IL-1β, and c-Myc, were detected. In vitro analysis was performed using hypoxia-induced rat renal tubular epithelial cells (NRK-52E) and IL-1β-stimulated rat renal interstitial fibroblasts (NRK-49F). IL-1β concentration in the culture medium and IL-1β protein expression in hypoxic NRK-52E treated with different concentrations of SSR were investigated. Furthermore, we also studied the changes in protein expression of c-Myc and fibrosis-related factors after c-Myc gene silencing in IL-1β-stimulated NRK-49F treated with SSR. Results. Shen Shuai II Recipe significantly reduced RIF and downregulated the expression of HIF-1α, c-Myc, and IL-1β proteins in 5/6 (A/I) rats with chronic renal failure. It also inhibited IL-1β secretion from NRK-52E induced by hypoxia, which in turn inhibited fibroblast activation mediated by the IL-1β/c-Myc pathway, and finally reduced the overproduction of the extracellular matrix. Conclusion. The renoprotective effects of SSR in rats with chronic renal failure may be related to its inhibition of hypoxia via the IL-1β/c-Myc pathway. Thus, SSR is a potentially effective drug for delaying the progression of renal interstitial fibrosis.

Renal disease

2018 ◽  
Author(s):  
Quentin Milner
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Renal Disease ◽  
Replacement Therapy ◽  
Impaired Renal Function ◽  
Anaesthetic Management

This chapter describes the anaesthetic management of the patient with renal disease. The topics include estimation of renal function, chronic kidney disease, renal replacement therapy (including haemodialysis), acute renal failure, and the patient with a transplanted kidney. For each topic, preoperative investigation and optimization, treatment, and anaesthetic management are described. The effects of impaired renal function on the elimination of anaesthetic drugs are discussed.

Understanding Renal Disorders

2012 ◽  
Author(s):  
Debra Ugboma ◽  
Helen Willis
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Renal Failure ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Renal Disorders ◽  
Department Of Health

The aim of this chapter is to provide nurses with the knowledge to be able to assess, manage, and care for people with the renal disorders chronic kidney disease (CKD) and acute kidney injury (AKI) in an evidence-based and person-centred way. In recent years, AKI has replaced the term ‘acute renal failure’. The chapter will provide a comprehensive overview of the causes, risk factors, and impact of CKD and AKI, before exploring best practice to deliver care, as well as to prevent further progression of these conditions. Nursing assessments and priorities are highlighted throughout, and further nursing management of some of the symptoms and common health problems associated with CKD and AKI can be found in Chapters 6, 9, 15, and 19, respectively. Chronic kidney disease (CKD) is the gradual and usually permanent loss of some kidney function over time (Department of Health, 2007). In CKD, the damage and decline in renal function usually occurs over years, and in early stages can go undetected (Department of Health, 2005a). CKD has rapidly moved up the healthcare agenda in recent years, primarily because of the links with cardiovascular risk, and with a shift in focus away from the treatment of established renal failure towards the detection and prevention of CKD in primary care (O’Donohue, 2009). Glomerular filtration rate (GFR) is an indicator of renal function and is the rate at which blood flows through, and is ‘filtered’ by, the kidney; a normal GFR is approximately 125 ml/min. CKD is classified into five stages according to an estimated glomerular filtration rate (eGFR) and, in the milder stages, further evidence of renal damage such as proteinuria and haematuria. This classification holds regardless of the underlying cause of kidney damage. The understanding of GFR is pivotal to caring for patients with renal disorders. Monitoring, management, and referral of the patient in the earlier stages of CKD became much clearer following the publication of the National Clinical Guidelines for the Management of Adults with Chronic Kidney Disease in Primary and Secondary Care (NICE, 2008a). Many people with stage 3 CKD, unless they have proteinuria, diabetes, or other comorbidity such as cardiovascular disease, have a good prognosis and can be managed in primary care (Andrews, 2008).

scholarly journals Suppression of HIV-1 replication by antiretroviral therapy improves renal function in persons with low CD4 cell counts and chronic kidney disease

AIDS ◽  
2008 ◽  
Vol 22 (4) ◽  
pp. 481-487 ◽  
Author(s):  
Robert C Kalayjian ◽  
Nora Franceschini ◽  
Samir K Gupta ◽  
Lynda A Szczech ◽  
Ezekiel Mupere ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Antiretroviral Therapy ◽  
Kidney Disease ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Cd4 Cell ◽  
Hiv 1

scholarly journals Long-Term Follow-Up Evaluation of Renal Function in Patients with Chronic Kidney Disease Undergoing Cardiac Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Eduesley Santana-Santos ◽  
Felipe Kenji Oshiro Kamei ◽  
Tarcísia Karoline do Nascimento ◽  
Anas Abou Ismail ◽  
Jurema da Silva Herbas Palomo ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Cardiac Surgery ◽  
Kidney Disease ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Kidney Injury ◽  
Perioperative Period

Background. Acute kidney injury (AKI) is a common complication of cardiac surgery but its long-term consequences, in patients with chronic kidney disease (CKD), are not known.Methods. We compared the long-term prognoses of CKD patients who developed (n=23) and did not develop (n=35) AKI during the period of hospitalization after undergoing coronary artery bypass graft (CABG). Fifty-eight patients who survived (69.6±8.4years old, 72% males, 83% Whites, 52% diabetics, baseline GFR:46±16 mL/min) were followed up for47.8±16.4months and treated for secondary prevention of events.Results. There were 6 deaths, 4 in the AKI+ and 2 in the AKI− group (Log-rank = 0.218), two attributed to CV causes. At the end of the study, renal function was similar in the two groups. One AKI− patient was started on dialysis. Only 4 patients had an increase in serum creatinine ≥ 0.5 mg/dL during follow-up.Conclusion. CKD patients developing AKI that survived the early perioperative period of coronary intervention present good renal and nonrenal long-term prognosis, compared to patients who did not develop AKI.

Renal disease

2021 ◽  
pp. 191-200
Author(s):  
Quentin Milner
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Renal Disease ◽  
Replacement Therapy ◽  
Impaired Renal Function ◽  
Anaesthetic Management

This chapter describes the anaesthetic management of the patient with renal disease. The topics include estimation of renal function; chronic kidney disease; renal replacement therapy (including haemodialysis); acute renal failure, and the patient with a transplanted kidney. For each topic, pre-operative investigation and optimisation, treatment, and anaesthetic management are described. The effects of impaired renal function on the elimination of anaesthetic drugs are discussed.

Renal disease

2016 ◽  
Author(s):  
Quentin Milner
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Renal Disease ◽  
Replacement Therapy ◽  
Impaired Renal Function ◽  
Anaesthetic Management

This chapter describes the anaesthetic management of the patient with renal disease. The topics include estimation of renal function, chronic kidney disease, renal replacement therapy (including haemodialysis), acute renal failure, and the patient with a transplanted kidney. For each topic, preoperative investigation and optimization, treatment, and anaesthetic management are described. The effects of impaired renal function on the elimination of anaesthetic drugs are discussed.

scholarly journals Emergence of T cell immunosenescence in diabetic chronic kidney disease

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Yen-Ling Chiu ◽  
Wan-Chuan Tsai ◽  
Ruo-Wei Hung ◽  
I-Yu Chen ◽  
Kai-Hsiang Shu ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Renal Failure ◽  
T Cells ◽  
Renal Function ◽  
T Cell ◽  
Kidney Disease ◽  
Glucose Control ◽  
Diabetic Patients

Abstract Background Type 2 diabetes is an important challenge given the worldwide epidemic and is the most important cause of end-stage renal disease (ESRD) in developed countries. It is known that patients with ESRD and advanced renal failure suffer from immunosenescence and premature T cell aging, but whether such changes develop in patients with less severe chronic kidney disease (CKD) is unclear. Method 523 adult patients with type 2 diabetes were recruited for this study. Demographic data and clinical information were obtained from medical chart review. Immunosenescence, or aging of the immune system was assessed by staining freshly-obtained peripheral blood with immunophenotyping panels and analyzing cells using multicolor flow cytometry. Result Consistent with previously observed in the general population, both T and monocyte immunosenescence in diabetic patients positively correlate with age. When compared to diabetic patients with preserved renal function (estimated glomerular filtration rate > 60 ml/min), patients with impaired renal function exhibit a significant decrease of total CD3+ and CD4+ T cells, but not CD8+ T cell and monocyte numbers. Immunosenescence was observed in patients with CKD stage 3 and in patients with more severe renal failure, especially of CD8+ T cells. However, immunosenescence was not associated with level of proteinuria level or glucose control. In age, sex and glucose level-adjusted regression models, stage 3 CKD patients exhibited significantly elevated percentages of CD28−, CD127−, and CD57+ cells among CD8+ T cells when compared to patients with preserved renal function. In contrast, no change was detected in monocyte subpopulations as renal function declined. In addition, higher body mass index (BMI) is associated with enhanced immunosenescence irrespective of CKD status. Conclusion The extent of immunosenescence is not significantly associated with proteinuria or glucose control in type 2 diabetic patients. T cells, especially the CD8+ subsets, exhibit aggravated characteristics of immunosenescence during renal function decline as early as stage 3 CKD. In addition, inflammation increases since stage 3 CKD and higher BMI drives the accumulation of CD8+CD57+ T cells. Our study indicates that therapeutic approaches such as weight loss may be used to prevent the emergence of immunosenescence in diabetes before stage 3 CKD.

EFFECTIVENESS OF ANTIAGGREGANT THERAPY ON KIDNEY ACTIVITY IN THE PREDIALYSIS STAGE OF CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 6 (1) ◽  
pp. 55-60
Author(s):  
Khabib Barnoev ◽  
◽  
Sherali Toshpulatov ◽  
Nozima Babajanova ◽  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Comparative Study ◽  
Functional Status ◽  
Stage Ii ◽  
Term Administration ◽  
Antiaggregant Therapy

The article presents the results of a study to evaluate the effectiveness of antiaggregant therapy on the functional status of the kidneys in 115 patients with stage II and III chronic kidney disease on the basis of a comparative study of dipyridamole and allthrombosepin. Studies have shown that long-term administration of allthrombosepin to patients has led to improved renal function.

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