scholarly journals Cholemic Nephropathy as Cause of Acute and Chronic Kidney Disease. Update on an Under-Diagnosed Disease

Life ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1200
Author(s):  
Francesca Tinti ◽  
Ilaria Umbro ◽  
Mariadomenica D’Alessandro ◽  
Silvia Lai ◽  
Manuela Merli ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Prolonged Exposure ◽  
Renal Involvement ◽  
Kidney Injury ◽  
Diagnosis And Treatment ◽  
Prognostic Scores ◽  
Renal Outcome ◽  
Clinical Settings ◽  
Severe Hyperbilirubinemia

Cholemic nephropathy (CN) is a recognized cause of acute kidney injury (AKI) in patients with severe hyperbilirubinemia (sHyb) and jaundice. Pathophysiological mechanisms of CN are not completely understood, but it seems caused both by direct toxicity of cholephiles and bile casts formation in nephrons enhanced by prolonged exposure to sHyb, particularly in the presence of promoting factors, as highlighted by a literature reviewed and by personal experience. The aim of our update is to retrace CN in its pathophysiology, risk factors, diagnosis and treatment, underlining the role of sHyb, promoting factors, and CN-AKI diagnostic criteria in the different clinical settings associated with this often-concealed disease. Our purpose is to focus on clinical manifestation of CN, exploring the possible transition to CKD. Cholemic nephropathy is an overlooked clinical entity that enters differential diagnosis with other causes of AKI. Early diagnosis and treatment are essential because renal injury could be fully reversible as rapidly as bilirubin levels are reduced. In conclusion, our proposal is to introduce an alert for considering CN in diagnostic and prognostic scores that include bilirubin and/or creatinine with acute renal involvement, with the aim of early diagnosis and treatment of sHyb to reduce the burden on renal outcome.

Neuromyelitis optica spectrum: novel concept of pathogenesis, diagnosis and treatment of Devic’s disease

2009 ◽  
Vol 150 (46) ◽  
pp. 2101-2109 ◽  
Author(s):  
Péter Csécsei ◽  
Anita Trauninger ◽  
Sámuel Komoly ◽  
Zsolt Illés
Keyword(s):  
Neuromyelitis Optica ◽  
Water Channel ◽  
Diagnostic Procedures ◽  
Diagnosis And Treatment ◽  
Clinical Settings ◽  
Permanent Disability ◽  
Therapeutic Decisions ◽  
Novel Concept ◽  
The Brain

The identification of autoantibodies generated against the brain isoform water channel aquaporin4 in the sera of patients, changed the current diagnostic guidelines and concept of neuromyelitis optica (NMO). In a number of cases, clinical manifestation is spatially limited to myelitis or relapsing optic neuritis creating a diverse. NMO spectrum. Since prevention of relapses provides the only possibility to reduce permanent disability, early diagnosis and treatment is mandatory. In the present study, we discuss the potential role of neuroimaging and laboratory tests in differentiating the NMO spectrum from other diseases, as well as the diagnostic procedures and therapeutic options. We also present clinical cases, to provide examples of different clinical settings, diagnostic procedures and therapeutic decisions.

scholarly journals Proteinuria Indicates Decreased Normal Glomeruli in ANCA-Associated Glomerulonephritis Independent of Systemic Disease Activity

2021 ◽  
Vol 10 (7) ◽  
pp. 1538
Author(s):  
Désirée Tampe ◽  
Peter Korsten ◽  
Philipp Ströbel ◽  
Samy Hakroush ◽  
Björn Tampe
Keyword(s):  
Disease Activity ◽  
Systemic Disease ◽  
Renal Involvement ◽  
Kidney Injury ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Clinicopathological Characteristics ◽  
Renal Outcome ◽  
Study Results ◽  
Renal Biopsies ◽  
Stage Renal Disease

Background: Renal involvement is a common and severe complication of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), potentially resulting in a pauci-immune necrotizing and crescentic ANCA glomerulonephritis (GN) with acute kidney injury (AKI), end-stage renal disease (ESRD) or death. There is recent evidence that the degree of proteinuria at diagnosis is associated with long-term renal outcome in ANCA GN. Therefore, we here aimed to systematically describe the association between proteinuria and clinicopathological characteristics in 53 renal biopsies with ANCA GN and corresponding urinary samples at admission. Methods: A total number of 53 urinary samples at admission and corresponding renal biopsies with confirmed renal involvement of AAV were retrospectively included from 2015 to 2021 in a single-center study. Results: Proteinuria correlated with myeloperoxidase (MPO) subtype, diagnosis of microscopic polyangiitis (MPA) and severe deterioration of kidney function. Proteinuria was most prominent in sclerotic class ANCA GN and ANCA renal risk score (ARRS) high risk attributed to nonselective proteinuria, including both glomerular and tubular proteinuria. Finally, there was no association between proteinuria and systemic disease activity, suggesting that proteinuria reflected specific renal involvement in AAV rather that systemic disease activity. Conclusions: In conclusion, proteinuria correlated with distinct clinicopathological characteristics in ANCA GN, mostly attributed to a reduced fraction of normal glomeruli. Furthermore, proteinuria in ANCA GN reflected specific renal involvement in AAV rather than systemic disease activity. Therefore, urinary findings could further improve our understanding of mechanisms promoting kidney injury and progression of ANCA GN.

scholarly journals The role of membrane-destabilizing processes in the pathogenesis and clinical manifestations of perinatal encephalopathy in children

2001 ◽  
Vol 82 (2) ◽  
pp. 137-138
Author(s):  
E. V. Levitina ◽  
G. A. Ivanichev ◽  
M. M. Minnibaev
Keyword(s):  
Nervous System ◽  
Early Diagnosis ◽  
Clinical Manifestations ◽  
Perinatal Period ◽  
Diagnosis And Treatment ◽  
Definition Of ◽  
Methods Of Treatment ◽  
All Diseases ◽  
Made In

2/3 of all diseases of the nervous system in children begin to develop in the perinatal period. In recent decades, great strides have been made in perinatal neurology in the development of criteria for early diagnosis and treatment of diseases. Further study of the biochemical foundations of perinatal lesions of the nervous system with the definition of objective markers of the severity of the lesion will reveal new links in its pathogenesis and develop more effective methods of treatment.

Popliteal artery entrapment syndrome: The role of early diagnosis and treatment

Surgery ◽  
1997 ◽  
Vol 122 (1) ◽  
pp. 26-31 ◽  
Author(s):  
Luca di Marzo ◽  
Antonino Cavallaro ◽  
Andrea Mingoli ◽  
Paolo Sapienza ◽  
Manfredo Tedesco ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Popliteal Artery ◽  
Diagnosis And Treatment ◽  
Entrapment Syndrome ◽  
Popliteal Artery Entrapment Syndrome ◽  
Popliteal Artery Entrapment

scholarly journals The Predictive Role of New Markers in Early Diagnosis of Acute Kidney Injury in Patients with Acute Pancreatitis

2020 ◽  
Vol 10 (03) ◽  
pp. 254-263
Author(s):  
Ferdi Karagöz ◽  
Dede Sit ◽  
Aysegül Kirankaya ◽  
Yasemin Aker Karagöz ◽  
Arif Savas ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Acute Pancreatitis ◽  
Early Diagnosis ◽  
Kidney Injury ◽  
Predictive Role

Role of the General Surgeon in the Early Diagnosis and Treatment of Charcot’ Foot

2015 ◽  
Vol 93 (5) ◽  
pp. 320-325
Author(s):  
Rafael Sellés Dechent ◽  
Camilo Rueda Alcárcel ◽  
Vicent Primo Romaguera ◽  
Asunción Martínez Caamaño ◽  
Francisco Asencio Arana
Keyword(s):  
Early Diagnosis ◽  
Diagnosis And Treatment ◽  
General Surgeon ◽  
Charcot Foot

scholarly journals Serum klotho as a marker for early diagnosis of acute kidney injury after cardiac surgery

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Aleš Jerin ◽  
Osama F Mosa ◽  
Jurij M Kališnik ◽  
Janez Žibert ◽  
Milan Skitek
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Early Diagnosis ◽  
Lower Risk ◽  
Kidney Injury ◽  
Tree Model ◽  
Significant Difference ◽  
Better Than

SummaryBackgroundEarly diagnosis of acute kidney injury (AKI) after cardiac surgery is based on serum creatinine which is neither a specific nor a sensitive biomarker. In our study, we investigated the role of serum Klotho in early prediction of AKI after cardiac surgery using cardiopulmonary bypass (CPB).MethodsThe included patients were classified into three groups according to AKI stages using KDIGO criteria. The measurements of creatinine and Klotho levels in serum were performed before surgery, at the end of CPB, 2 hours after the end of CPB, 24 hours and 48 hours postoperatively.ResultsSeventy-eight patients were included in the study. A significant increase of creatinine levels (p<0.001) was measured on the first day after the surgery in both AKI groups compared to the non-AKI group. However, a significant difference between AKI-2 and AKI-1 groups (p=0.006) was not measured until the second day after the operation. Using decision trees for classification of patients with a higher or lower risk of AKI we found out that Klotho discriminated between the patients at low risk of developing more severe kidney injury in the first hours after surgery and the patients at high risk better than creatinine. Adding also the early measurements of creatinine in the decision tree model further improved the prediction of AKI.ConclusionSerum Klotho may be useful to discriminate between the patients at lower and the patients at higher risk of developing severe kidney injury after cardiac surgery using CPB already in the first hours after surgery.

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