Nephron. Physiology
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Nephron. Physiology · Jan 2014
Is the systemic microvascular endothelial glycocalyx in peritoneal dialysis patients related to peritoneal transport?
The capillary wall coated by the endothelial glycocalyx is the main transport barrier during peritoneal dialysis (PD). Here, we investigated the relationships between measurements of the systemic endothelial glycocalyx and peritoneal transport in PD patients. ⋯ No relationships are present between the systemic endothelial glycocalyx, which was assessed by SDF, and peritoneal transport. In nonfast transporters, a reduction in blood vessel density caused by endothelial glycocalyx alterations or a thicker permeable phase of the glycocalyx delaying the access of small solutes to the small pores may be important. .
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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 2013
ReviewFluid balance in patients with acute kidney injury: emerging concepts.
Intensive care unit and surgical populations are at increased risk for acute kidney injury (AKI) and oliguria, which often lead to fluid accumulation. Volume resuscitation is a cornerstone in the treatment of hemodynamic instability in these populations. However, fluid balance evaluation and its management in the critically ill can be challenging. ⋯ Instead, approaches that aim for neutral and slightly negative fluid balance or 'dry' patients after initial fluid resuscitation are favored. This may be achieved by conservative fluid strategies, diuretics or renal replacement therapy. In this paper, we will review recent findings on the principles of fluid management in AKI, including assessment of fluid need, choice of fluid solutions, influence of fluid overload on outcomes, and some practical issues to achieve fluid balance and minimize complications in patients with AKI.
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Nephron. Physiology · Jan 2013
Beyond the randomized clinical trial: citrate for continuous renal replacement therapy in clinical practice.
Premature circuit clotting is a major problem during continuous renal replacement therapy (CRRT). Six randomized controlled trials confirmed that regional anticoagulation with citrate is superior to heparin. Our objective was to compare circuit patency with citrate, heparin and epoprostenol in routine clinical practice. ⋯ In routine clinical practice, regional anticoagulation with citrate is associated with significantly better circuit patency than heparin or epoprostenol.