Contributions to nephrology
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Clinical Trial
Continuous hemodiafiltration using a polymethyl methacrylate membrane hemofilter for severe acute pancreatitis.
It has been reported that hypercytokinemia plays a pivotal role in the pathophysiology of severe acute pancreatitis (SAP). In our previous reports, continuous hemodiafiltration (CHDF) using a polymethyl methacrylate (PMMA) membrane hemofilter (PMMA-CHDF) was found to be capable of efficiently removing various cytokines from circulating blood. The present study was undertaken to evaluate the efficacy of PMMA-CHDF aimed at cytokine removal in the treatment of SAP. ⋯ At the time of weaning from PMMA-CHDF, blood IL-6 level had decreased to 99 pg/ml. The mortality rate among patients who received PMMA-CHDF was 6.1%, and significantly lower than that of patients before the introduction of PMMA-CHDF under non-renal indication (25.0%). These findings suggest that PMMA-CHDF is effective for treatment of SAP and that it can be expected to contribute to improving the outcome of SAP patients.
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Comparative Study Controlled Clinical Trial
Efficacy of continuous hemodiafiltration with a cytokine-adsorbing hemofilter in the treatment of acute respiratory distress syndrome.
In the pathophysiology of acute respiratory distress syndrome (ARDS), the increase in capillary and alveolar permeability caused by various humoral mediators and resultant pulmonary interstitial edema play major roles. In this study, the efficacy of continuous hemodiafiltration using a cytokine-adsorbing hemofilter with a membrane made of polymethylmethacrylate (PMMA-CHDF) in the treatment of ARDS patients was investigated. ⋯ Cytokine removal therapy with PMMA-CHDF is expected to be useful as a new therapeutic modality in ARDS patients for non-renal indications.
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Endotoxin activity (EA) plays an essential role in sepsis syndrome pathogenesis. There has been considerable interest in measuring and removing EA to predict and improve the morbidity and mortality of patients with sepsis. We performed a prospective study to assess the prevalence of EA in critically ill patients and its association with organ dysfunction and outcome, as well as in septic shock. ⋯ Our study demonstrated that EA level is independent from the type or the source of infection, but reflects the severity of illness in critically ill septic shock patients. Extracorporeal EA removal (PMX-HP) was assessed following our ICU clinical practice. PMX-HP seems to have better outcome, but further studies are required to verify this hypothesis.
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During critical illness, reductions in renal blood flow (RBF) are believed to be a major cause of kidney dysfunction, and therapy is often aimed at restoration of RBF. Despite this, our ability to measure RBF during critical illness has been limited by the invasiveness of the available techniques. Ciné Phase-Contrast Magnetic Resonance Imaging (CPC-MRI) represents an entirely noninvasive, contrast-free method of measuring blood flow with the potential of enabling the measurement of blood flow to major organs including the kidney. We have recently assessed the feasibility of measuring RBF by means of CPC-MRI in 2 critically ill patients with septic acute kidney injury and were able to compare such measurements to those obtained in a normal volunteer.
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Acute kidney injury (AKI) is a common complication of critical illness. While the etiology of AKI in critically ill patients is likely often multifactorial, sepsis has consistently been found an important contributing factor and has been associated with high attributable morbidity and mortality. Accordingly, the timely identification of septic AKI in critically ill patients is clearly a clinical priority. ⋯ In addition, several urinary biochemical tests, derived indices and microscopy have also been widely cited as valuable in the diagnosis and classification of AKI. However, the value of these urinary tests in the diagnosis, classification, prognosis and clinical management in septic AKI remains unclear, due in part to a lack of kidney morphologic changes and histopathology in human studies of septic AKI. This review will summarize the urinary biochemistry and microscopy in septic AKI.