scholarly journals Hyperfiltration and Albuminuria—A Deadly Combination

2017 ◽  
Vol 13 (01) ◽  
pp. 12
Author(s):  
Claude K Lardinois ◽  
Keyword(s):  
Chronic Kidney Disease ◽  
Coronary Heart Disease ◽  
End Stage Renal Disease ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Creatinine Ratio ◽  
Chd Risk ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage

I ndividuals with chronic kidney disease (CKD) are at high risk of coronary heart disease (CHD), and roughly half die of CHD without developing end-stage renal disease. Two key kidney measurements: estimated glomerular filtration rate (eGFR) and albuminuria, are consistently associated with high CHD risk. An eGFR greater than 105 ml/min per 1.73m2 (hyperfiltration) and an albumin-to-creatinine ratio (ACR) greater than 5 mg/g are both independently associated with an increased risk of CHD. Therefore, eGFR and ACR should be taken into account for cardiovascular prediction.

Management of Chronic Kidney Disease and its Complications

2018 ◽  
Author(s):  
Joshua S. Hundert ◽  
Ajay K Singh
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Renal Failure ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Filtration Rate ◽  
Stage Renal Disease ◽  
End Stage

Management of early renal failure helps in the reduction or prevention of end-stage renal disease. The monitoring of renal function is discussed, and the chapter includes a table that shows commonly used methods for monitoring. Risk factors for chronic renal failure include stroke and cardiac disease. Risk factors for renal disease progression are diabetes mellitus, hypertension, proteinuria, smoking, protein intake, and hyperlipidemia. Complications of chronic renal failure that are addressed include sodium and water imbalance, potassium imbalance, acidosis, calcium and phosphorus imbalance, and anemia. There is also a section that discusses the case for early referral to a nephrologist. Tables present the equations used to estimate the glomerular filtration rate (GFR); stages of chronic kidney disease and the appropriate steps in their management; risk factors for chronic kidney disease in which the testing of proteinuria and estimation of GFR are indicated; appropriate diet for patients who have chronic kidney disease; and guidelines for diagnosing and treating anemia resulting from chronic kidney disease. An algorithm outlines the steps in management of calcium and phosphate in patients with kidney disease. This review contains 3 figures, 10 tables and 50 references Key Words End-stage renal disease, chronic kidney disease, glomerular filtration rate, Modification of Diet in Renal Disease, Proteinuric renal disease, Hyperuricemia

Ertapenem-induced encephalopathy

2020 ◽  
Vol 13 (6) ◽  
pp. e231875
Author(s):  
Rebecca Adams ◽  
Priya Chopra ◽  
Richard Miranda ◽  
Aaron Calderon
Keyword(s):  
Intensive Care Unit ◽  
Mental Status ◽  
End Stage Renal Disease ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Kidney Injury ◽  
Visual Hallucinations ◽  
Airway Protection ◽  
Stage Renal Disease ◽  
End Stage

Neurotoxicity is an unusual side effect of carbapenems, and it has been reported most commonly presenting as seizures, encephalopathy and hallucinations. Ertapenem neurotoxicity most classically presents as seizures in patients with end-stage renal disease (estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2). We present a patient with a baseline eGFR of 30–59 mL/min/1.73 m2 with acute kidney injury who developed non-seizure neurotoxicity after ertapenem exposure. This patient is a middle-aged Caucasian man who received intravenous ertapenem for treatment of empyema. Although the empyema improved, he developed delirium beginning on day 7 of ertapenem. The delirium progressed to constant agitation and visual hallucinations requiring transfer to the intensive care unit with eventual intubation for airway protection. No improvement in mental status was observed with cessation of other medications. Ertapenem was discontinued and within 24 hours, he was extubated, and his mental status returned to baseline. He was discharged from the hospital the following day. The timely resolution after ertapenem discontinuation makes ertapenem-induced encephalopathy the most likely explanation for this patient’s course.

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