Sugammadex: What to Know for Your Daily Practice

Sugammadex (Bridion) represents a class named muscle relaxant encapsulator. It can be used to reverse the neuromuscular blockade induced by rocuronium or vecuronium in case of general anesthesia. Its molecular weight is 2.178 g/mol, with a structure consisting in a ring of eight negative charges. It has no receptor interaction in human body and it is eliminated via kidney, being contraindicated in end-stage kidney disease patients. Sugammadex has few side effects but there are same case reports about allergic reactions. Only three drugs can actually interact with sugammadex: toremifene, flucloxacillin and fusidic acid. It can be used in elderly and pediatric patients, in morbidly obese patients, patients with hepatic insufficiency or mild and moderate renal insufficiency or in muscular disease. Despite its beneficial use, the high price remains its main issue.

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Chronic kidney disease, pregnancy and haemodialysis: Case reports from a single centre in Kenya and literature review

Obstetric Medicine ◽

10.1177/1753495x20985408 ◽

2021 ◽

pp. 1753495X2098540

Author(s):

Samuel K Kabinga ◽

Jackline Otieno ◽

John Ngige ◽

Seth O Mcligeyo

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Case Reports ◽

Tertiary Hospital ◽

Reproductive Age ◽

Review Of Literature ◽

Single Centre ◽

End Stage Kidney Disease ◽

Women Of Reproductive Age ◽

End Stage

Chronic kidney disease (CKD) and end stage kidney disease are prevalent even in women of reproductive age. These are known to reduce fertility and successful pregnancy. There are chances of conception even in advanced CKD, though laden with complications. We present two cases of women who conceived in advanced CKD and are on haemodialysis in a tertiary hospital in Kenya and review of literature.

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Hypercalcaemia in Mycobacterium kansasii pulmonary infection

BMJ Case Reports ◽

10.1136/bcr-2021-245800 ◽

2021 ◽

Vol 14 (11) ◽

pp. e245800

Author(s):

Robert Costigan Flowers ◽

Javier Ocampo ◽

Justin Krautbauer ◽

Warren L Kupin

Keyword(s):

Pulmonary Infection ◽

Case Reports ◽

Kidney Injury ◽

Disease Status ◽

Altered Mental Status ◽

Mycobacterium Kansasii ◽

End Stage Kidney Disease ◽

Granulomatous Diseases ◽

End Stage ◽

Work Up

A gentleman in his 60s with end-stage kidney disease status post kidney transplantation on prednisone and tacrolimus presented with generalised weakness for 7 days, associated with altered mental status. Investigations revealed pancytopenia, acute kidney injury, hypercalcaemia, decreased parathyroid hormone (PTH) and normal calcitriol levels. CT of the chest showed multifocal lung opacities suspicious for malignancy. Bronchoscopy with biopsy yielded no malignant cells, and bronchoalveolar lavage specimens grew Mycobacterium kansasii. The patient was treated with bisphosphonates, calcitonin and antibiotics for non-tuberculous mycobacteria pulmonary infection, with improvement in serum calcium levels, and was discharged after 5 weeks of hospitalisation.The work-up for hypercalcaemia begins with PTH measurement, and low PTH levels are consistent with malignancy, immobilisation and granulomatous diseases. Hypercalcaemia in the lattermost is classically caused by overproduction of calcitriol by activated macrophages. However, there are case reports of mycobacterial infections with hypercalcaemia despite normal calcitriol levels, supporting the existence of an additional mechanism of hypercalcaemia in granulomatous infections.

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Relationship between Plasma Fibroblast Growth Factor-23 Concentration and Bone Mineralization in Children with Renal Failure on Peritoneal Dialysis

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2008-0326 ◽

2009 ◽

Vol 94 (2) ◽

pp. 511-517 ◽

Cited By ~ 109

Author(s):

Katherine Wesseling-Perry ◽

Renata C. Pereira ◽

Hejing Wang ◽

Robert M. Elashoff ◽

Shobha Sahney ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Growth Factor ◽

Bone Histomorphometry ◽

Pediatric Patients ◽

Fibroblast Growth ◽

End Stage Kidney Disease ◽

End Stage ◽

Fgf 23 ◽

The Relationship ◽

Skeletal Mineralization

Abstract Context: Fibroblast growth factor (FGF)-23 is produced in bone, and circulating levels are markedly elevated in patients with end-stage kidney disease, but the relationship between plasma levels of FGF-23 and bone histology in dialysis patients with secondary hyperparathyroidism is unknown. Objective: The aim of the study was to evaluate the correlation between plasma levels of FGF-23 and bone histology in pediatric patients with end-stage kidney disease who display biochemical evidence of secondary hyperparathyroidism. Design: We performed a cross-sectional analysis of the relationship between plasma FGF-23 levels and bone histomorphometry. Setting: The study was conducted in a referral center. Study Participants: Participants consisted of forty-nine pediatric patients who were treated with maintenance peritoneal dialysis and who had serum PTH levels (1st generation Nichols assay) greater than 400 pg/ml. Intervention: There were no interventions. Main Outcome Measure: Plasma FGF-23 levels and bone histomorphometry were measured. Results: No correlation existed between values of PTH and FGF-23. Bone formation rates correlated with PTH (r = 0.44; P < 0.01), but not with FGF-23. Higher FGF-23 concentrations were associated with decreased osteoid thickness (r = −0.49; P < 0.01) and shorter osteoid maturation time (r = −0.48; P < 0.01). Conclusions: High levels of FGF-23 are associated with improved indices of skeletal mineralization in dialyzed pediatric patients with high turnover renal osteodystrophy. Together with other biomarkers, FGF-23 measurements may indicate skeletal mineralization status in this patient population.

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Delayed diagnoses of mitochondrial cytopathies in patients presenting with end stage kidney disease: two case reports

BMC Nephrology ◽

10.1186/s12882-020-02002-5 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Tayeba Roper ◽

Mark Harber ◽

Gareth Jones ◽

Robert D. S. Pitceathly ◽

Alan D. Salama

Keyword(s):

Kidney Disease ◽

Case Reports ◽

End Stage Kidney Disease ◽

Mitochondrial Cytopathies ◽

End Stage

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Diabetic ketoacidosis in people on maintenance haemodialysis: case reports and review of literature

British Journal of Diabetes ◽

10.15277/bjd.2020.253 ◽

2020 ◽

Vol 20 (2) ◽

pp. 89-95

Author(s):

Apexa Kuverji ◽

Kath Higgins ◽

James O Burton ◽

Andrew H Frankel ◽

Chee Kay Cheung

Keyword(s):

Renal Function ◽

Kidney Disease ◽

Case Reports ◽

Physiological State ◽

Review Of Literature ◽

End Stage Kidney Disease ◽

Maintenance Haemodialysis ◽

Comprehensive Literature Review ◽

End Stage ◽

Learning Points

The management of diabetes ketoacidosis (DKA) in people with normal renal function is well established. Although DKA is less common in people with end-stage kidney disease (ESKD), when it occurs, the management needs to be adapted to account for the different physiological state that these patients present with. This report presents two cases of DKA in people on maintenance haemodialysis for ESKD. Each case identifies learning points, when combined with a comprehensive literature review, generates key recommendations on the management of DKA in people on maintenance haemodialysis.

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