Nephron. Physiology
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Nephron. Physiology · Jan 2009
ReviewThe challenge of doing what is right in renal transplantation: balancing equity and utility.
Arguably the greatest challenge faced by the transplant community is the disparity between the number of persons waiting for a solid organ transplant and the finite supply of donor organs. For renal transplantation the gap between supply and demand has risen annually reflecting the increasing prevalence of end-stage renal disease versus the relatively static deceased donor organ pool. Maximising the benefit from this scarce resource raises difficult ethical issues. ⋯ The philosophies of equity (a fair opportunity for everyone in need to receive a transplant) and utility (optimal profit from each organ) are often competing. National allocation schemes and local policies regarding assessment of potential recipients and acceptance of organs are designed to balance these ethical principles in a standardized and socially acceptable manner. The ongoing debate surrounding these issues and modifications to such policies reflect the evolving clinical picture of renal transplantation and the challenge in maintaining equipoise between renal transplant utility and equity.
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In nephrology research, both observational studies and randomized controlled trials (RCTs) are commonly applied. Clinicians using the evidence from epidemiological studies should be aware of the specific qualities and limitations of each study design. ⋯ Conversely, observational study designs, including case reports, case series, cross-sectional studies, case-control studies and cohort studies, are usually more useful than RCTs for non-therapeutic research questions. In conclusion, both observational studies and RCTs fulfill a complementary and valuable role in nephrology.
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Nephron. Physiology · Jan 2009
Influence of obesity on progression of non-diabetic chronic kidney disease: a retrospective cohort study.
There is increasing awareness of the impact of obesity on chronic diseases including chronic kidney disease (CKD). Until recently, a limited number of epidemiologic studies have examined the association between obesity and CKD. We conducted a retrospective cohort study to evaluate whether obesity impacts on the rate of non-diabetic CKD progression. ⋯ Baseline BMI and young age are strongly and independently associated with faster CKD progression based on the annual rate of eGFR fall. Prospective studies to investigate the relationship between BMI and CKD and its complications are warranted.
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The spectrum of kidney functional and structural alterations in sickle cell hemoglobinopathy (SCH) is broad. Also, morbidity and mortality from end organ dysfunction, especially cardiorenal dysfunction, are substantial. Consequently, screening an SCH population prospectively for surrogate markers of cardiorenal risk such as albuminuria and intima-media thickness (IMT) was the aim of this cross-sectional study. ⋯ Markers of cardiorenal risk such as albuminuria and IMT are common findings in SCH patients of Arabic descent and could be useful screening tools to identify sicklers at risk for cardiovascular and renal events.
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Nephron. Physiology · Jan 2009
Comparative StudyInterleukin-8 and acute kidney injury following cardiopulmonary bypass: a prospective cohort study.
Cardiopulmonary bypass (CPB) elicits an inflammatory response mediated partly by neutrophils, which are activated and recruited by interleukin-8 (IL-8). We hypothesized that acute kidney injury (AKI) following CPB might be mediated by IL-8 and examined the association of perioperative plasma IL-8 levels with AKI in a prospective cohort. ⋯ Plasma IL-8 predicts the development of AKI following CPB, supporting a potential involvement for this chemokine in the pathogenesis of AKI.