Nephron. Physiology
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Nephron. Physiology · Jan 2014
Randomized Controlled TrialBolus administration of intravenous glucose in the treatment of hyperkalemia: a randomized controlled trial.
Hyperkalemia is a common medical emergency that may result in serious cardiac arrhythmias. Standard therapy with insulin plus glucose reliably lowers the serum potassium concentration ([K(+)]) but carries the risk of hypoglycemia. This study examined whether an intravenous glucose-only bolus lowers serum [K(+)] in stable, nondiabetic, hyperkalemic patients and compared this intervention with insulin-plus-glucose therapy. ⋯ Infusion of a glucose-only bolus caused a clinically significant decrease in serum [K(+)] without any episodes of hypoglycemia.
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Nephron. Physiology · Jan 2014
ReviewRenal functional reserve and renal recovery after acute kidney injury.
Renal functional reserve (RFR) represents the capacity of the kidney to increase glomerular filtration rate (GFR) in response to certain physiological or pathological stimuli or conditions. Once baseline GFR is determined, RFR can be assessed clinically after an oral protein load or intravenous amino acid infusion. In clinical practice, baseline GFR displays variable levels due to diet or other factors. ⋯ In case of healing with a defect and progressive fibrosis, recovery may appear complete clinically, but a reduced RFR may be a sign of a maladaptive repair or subclinical loss of renal mass. Thus, a reduction in RFR may represent the equivalent of renal frailty or susceptibility to insults. The main aim of this article is to review the concept of RFR, its utility in different clinical scenarios, and future perspective for its use.
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Nephron. Physiology · Jan 2014
ReviewHow can we define recovery after acute kidney injury? Considerations from epidemiology and clinical trial design.
The recent recognition that acute kidney injury (AKI) may lead to the development of chronic kidney disease and end-stage renal disease, with the attendant increase in mortality, has led to interest in the clinical epidemiology and the mechanistic understanding of renal recovery after an episode of AKI. At present, no uniform definition for recovery after AKI exists and various considerations should be taken into account in the development of a definition. Renal recovery after an AKI episode may affect clinical decision making around the initiation of renal replacement therapy, and has significant implication for biomarker assessment and identification of mechanistic targets to guide potential future clinical trials.
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Nephron. Physiology · Jan 2014
ReviewThe evolution of pediatric continuous renal replacement therapy.
The provision of continuous renal replacement therapies (CRRT) to small children has generally required the adaptation of adult machines and modified operational characteristics. CRRT prescription for younger and smaller children versus adults differs significantly due to problems concerning the extracorporeal blood volume, the need for circuit blood priming, and the adaptation of machines designed for adult-sized patients. ⋯ In 2012, a dedicated machine, i.e. the Cardio-Renal, Pediatric Dialysis Emergency Machine (CARPEDIEM), was developed and launched the 'fitted era' for pediatric CRRT. In this review, we analyze how CRRT techniques have evolved for pediatric application and describe the first in vivo application of the CARPEDIEM for the safe and efficacious provision of CRRT to infants.
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Nephron. Physiology · Jan 2014
Multicenter Study Observational StudyTransient versus persistent acute kidney injury and the diagnostic performance of fractional excretion of urea in critically ill patients.
To evaluate the performance of fractional excretion of urea (FeU) for differentiating transient (T) from persistent (P) acute kidney injury (AKI) and to assess performance of FeU in predicting AKI in patients admitted to the ICU. ⋯ FeU does not seem to be helpful in differentiating T- from P-AKI in critically ill patients and it is a poor predictor of AKI.