Presentation, clinical behavior, outcomes and therapies for patients with advanced pancreas adenocarcinoma (PAC) who present with or develop ascites.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 209-209
Author(s):  
Angel Mier Hicks ◽  
Eileen Mary O'Reilly ◽  
Marinela Capanu ◽  
Maeve Aine Lowery ◽  
Kenneth H. Yu
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Bowel Perforation ◽  
Malignant Ascites ◽  
Cancer Center ◽  
Poor Prognostic Factor ◽  
Indwelling Catheters ◽  
Bacterial Peritonitis ◽  
Catheter Malfunction ◽  
Prognostic Importance

209 Background: Ascites develops in a subset of patients with PAC at presentation or as the disease advances. Limited data exist on the prognostic importance of malignant ascites in PAC. Our hypothesis is that this information will provide an understanding of the natural history and facilitate management decisions. Methods: We conducted a retrospective analysis of N = 180 patients treated at Memorial Sloan Kettering Cancer Center diagnosed between January 1, 2009 and December 31, 2014, with PAC and ascites either at presentation or which developed during the disease course. Results: For the 180 patients, overall survival was 15 months. Time from diagnosis to ascites presentation was 11 months and survival time after ascites development was 4 months. Of 62 patients (34%) who had ascitic fluid analyzed, N = 36 (58%) had positive cytology, N = 51 (82%) patients had a serum ascites albumin gradient (SAAG) ≥ 1 and N = 11 (18%) had SAAG < 1.1. Sixty-four (36%) of patients had their ascites managed solely by serial paracenteses. A total of 116 patients required a catheter, from these, N = 108 (93%) had a Tenckhoff catheter, N = 4 (3%) Pleurx catheter, N = 3 (2%) Pigtail catheter and one (1%) a Denver catheter. Eight (4%) patients required two catheters to be placed and N = 6 (3%) Tenckhoff catheters had to be removed. Main observed complications: spontaneous bacterial peritonitis in N = 7 (11%) of patients managed with paracenteses vs. N = 34 (19%) who had a catheter placed, catheter malfunction in N = 8 (4%), acute renal failure in N = 6 (3%). After ascites development N = 79 (44%) of patients received active therapy and N = 101 (56%) patients were managed with supportive care alone. Conclusions: In patients with PAC the presence of ascites is a poor prognostic factor. Serial paracenteses and indwelling catheters are common methods used for alleviating patients’ discomfort. The complication rate was higher with indwelling catheters, primarily associated with infections (e.g. bacterial peritonitis) with low rates of complications occurring related to catheter malfunction, acute renal failure or bowel perforation.

scholarly journals The elderly patient with acute renal failure.

1995 ◽  
Vol 6 (2) ◽  
pp. 144-153
Author(s):  
J Pascual ◽  
F Liaño ◽  
J Ortuño
Keyword(s):  
Elderly Patient ◽  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
The Elderly ◽  
Functional Changes ◽  
Therapeutic Decisions ◽  
Prognostic Importance ◽  
Work Up ◽  
Aging Kidney

Structural and functional changes observed in the aging kidney predispose the elderly patient to acute renal failure. Up to 36% of the patients with acute renal failure from this institution were over 70 yr, and the literature is full of similar experiences. The elderly patient with abrupt cessation of adequate renal function requires a special work-up in diagnosis and treatment. Prerenal and obstructive causes are of particular interest. Although the question of whether or not age has an independent prognostic importance during an episode of acute renal failure remains debated; when these and other authors compared the outcome of young and old populations with these disorders, a similar evolution was always observed. Age should not be used as a discriminant factor in therapeutic decisions concerning acute renal failure.

scholarly journals Uric Acid as a Marker of Kidney Disease: Review of the Current Literature

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Christin Giordano ◽  
Olga Karasik ◽  
Kelli King-Morris ◽  
Abdo Asmar
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Uric Acid ◽  
Kidney Disease ◽  
Current Literature ◽  
Predictive Models ◽  
Potential Role ◽  
Poor Prognostic Factor

Uric acid has been implicated in the pathophysiology of renal disease; however renal clearance makes a causal relationship difficult to prove. We examine the current literature to support a potential role of uric acid in the development of kidney disease and to determine the potential to use uric acid as a marker for future renal decline. After review, we conclude that uric acid is definitively linked to the development of chronic kidney disease and can be a poor prognostic factor for the development of acute renal failure, as well. However, further human research is needed before predictive models utilizing uric acid can be developed and used in the clinical setting.

scholarly journals Spontaneous Bacterial Peritonitis due toLactobacillus paracaseiin Cirrhosis

2018 ◽  
Vol 2018 ◽  
pp. 1-2 ◽  
Author(s):  
Emily Harding-Theobald ◽  
Bharat Maraj
Keyword(s):  
Renal Failure ◽  
Spontaneous Bacterial Peritonitis ◽  
Hepatorenal Syndrome ◽  
Case Reports ◽  
Bowel Perforation ◽  
High Dose ◽  
Human Gastrointestinal Tract ◽  
Bacterial Peritonitis ◽  
Standard Management ◽  
Antibiotic Coverage

Lactobacillusspecies colonize the human gastrointestinal tract and are rarely pathogenic. We present a case involving a cirrhotic patient who presented with sepsis and was found to have peritoneal cultures demonstratingLactobacillusas the sole pathogen concerning for spontaneous bacterial peritonitis. Treatment was achieved with high-dose penicillin and clindamycin but the patient developed hepatorenal syndrome and died from acute renal failure. Intra-abdominalLactobacillusinfections are typically seen in patients undergoing peritoneal dialysis or who have recently had bowel perforation. There are few case reports of spontaneousLactobacillusperitonitis in patients with cirrhosis. Our case report addresses the challenges ofLactobacillustreatment and suggests antibiotic coverage of commensal organisms in patients who do not improve with standard management.

scholarly journals Prognostic factors of acute renal failure following partial nephrectomy of solitary kidney

2018 ◽  
Vol 14 (2) ◽  
pp. 33-42
Author(s):  
L. N. Suslov ◽  
O. G. Sukonko ◽  
L. V. Mirilenko
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Postoperative Period ◽  
Tumor Size ◽  
Potassium Level ◽  
Predictive Accuracy ◽  
Solitary Kidney ◽  
Multivariate Model ◽  
Prognostic Models ◽  
Cancer Center

Background. Acute renal failure (ARF) in the postoperative period increases the risk of complications and death. Estimating the risk of ARF prior to surgery is particularly important, because it allows modifying the treatment in high-risk patients.Objective: to develop prognostic models for evaluating the risks of ARF in patients undergoing resection of a solitary kidney by measuring preoperative parameters.Materials and methods. The study included 136 patients with tumors in a solitary kidney that underwent surgical treatment in the N.N. Alexandrov National Cancer Center of Belarus in the last 16 years.Results. Biochemical blood tests demonstrated that 28 patients (20.6 %) had ARF in the early postoperative period. The multivariate model for assessing the risk of ARF included the following three covariates: tumor size, multifocality, and serum potassium level. We identified the cut-off points of tumor size (3.6 and 5.2 cm) and potassium level (4.4 and 4.8 mmol/L) that ensured maximum predictive accuracy. Using the multivariate model, we developed a nomogram that allows graphical calculation of the ARF probability in the postoperative period by measuring preoperative parameters.Conclusion. Our model enables preoperative assessment of the risk of developing ARF after resection of a solitary kidney with an accuracy (С-index) of 85.1 % (95 % confidence interval: 79.3–89.7 %).

Peritoneal Dialysis for Management of Pediatric Acute Renal Failure

2001 ◽  
Vol 21 (4) ◽  
pp. 390-394 ◽  
Author(s):  
Joseph T. Flynn ◽  
David B. Kershaw ◽  
William E. Smoyer ◽  
Patrick D. Brophy ◽  
Kevin D. McBryde ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Tertiary Care ◽  
Organ Transplant ◽  
Pediatric Intensive Care ◽  
Renal Replacement Therapies ◽  
Continuous Renal Replacement Therapies ◽  
Catheter Malfunction

Background While the use of continuous renal replacement therapies in the management of children with acute renal failure (ARF) has increased, the role of peritoneal dialysis (PD) in the treatment of pediatric ARF has received less attention. Design Retrospective database review of children requiring PD for ARF over a 10-year period. Setting Pediatric intensive care unit at a tertiary-care referral center. Patients Sixty-three children without previously known underlying renal disease who required PD for treatment of ARF. Results Causes of ARF were congestive heart failure (27), hemolytic-uremic syndrome ( 13 ), sepsis ( 10 ), nonrenal organ transplant ( 7 ), malignancy ( 3 ), and other ( 3 ). Mean duration of PD was 11 ± 13 days. Children with ARF were younger (30 ± 48 months vs 88 ± 68 months old, p < 0.0001) and smaller (11.9 ± 15.9 kg vs 28 ± 22 kg, p < 0.0001) than children with known underlying renal disease who began PD during the same time period. Percutaneously placed PD catheters were used in 62% of children with ARF, compared to 4% of children with known renal disease ( p < 0.0001). Hypotension was common in patients with ARF (46%), which correlated with a high frequency of vasopressor use (78%) at the time of initiation of PD. Complications of PD occurred in 25% of patients, the most common being catheter malfunction. Recovery of renal function occurred in 38% of patients; patient survival was 51%. Conclusions Peritoneal dialysis remains an appropriate therapy for pediatric ARF from many causes, even in severely ill children requiring vasopressor support. Such children can be cared for without the use of more expensive and technology-dependent forms of renal replacement therapies.

scholarly journals Incidence and Prognostic Importance of Acute Renal Failure After Percutaneous Coronary Intervention

Circulation ◽  
2002 ◽  
Vol 105 (19) ◽  
pp. 2259-2264 ◽  
Author(s):  
Charanjit S. Rihal ◽  
Stephen C. Textor ◽  
Diane E. Grill ◽  
Peter B. Berger ◽  
Henry H. Ting ◽  
...  
Keyword(s):  
Renal Failure ◽  
Percutaneous Coronary Intervention ◽  
Acute Renal Failure ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Prognostic Importance
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