International urology and nephrology
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The elderly population is more prone to acute kidney injury (AKI) than younger populations. Older patients have less renal reserve because of reduced glomerular filtration rates due to anatomic/functional changes, and concomitant diseases such as hypertension, diabetes, atherosclerosis, heart failure, ischemic renal disease, and obstructive uropathy. The risk of AKI may also increase as a result of aggressive diagnostic and therapeutic procedures, which include medical agents, radiology, and surgical intervention. ⋯ The majority of critically ill patients with AKI will eventually need renal replacement therapy (RRT). The influence of RRT on renal outcome remains a subject of intense investigation and debate. Avoiding situations that could damage the kidney is an important strategy to prevent AKI development in the elderly, besides medical and interventional therapeutics.
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Direct renin inhibitors are the first new class of antihypertensive to emerge since angiotensin II receptor blockers. We discuss their reno- and cardioprotective potential, based on extrapolation from animal models and phase three trials that are currently ongoing. This paper reviews the potential benefits of direct renin inhibitors (DRIs), the only new anti-hypertensive class developed in the last decade, as compared to pre-existing classes of drug inhibiting more downstream, such as Angiotensin Converting Enzyme inhibitors (ACEI), Angiotensin 2 Receptor Blockers (ARBS).
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On occasion, difficulty will be encountered removing an indwelling urethral catheter. This may be as a consequence of failure of the catheter balloon to deflate. This article reviews the published data on managing the non-deflating Foley catheter balloon, and suggests an evidence-based sequence of interventions to deflate the catheter balloon.
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Despite the usefulness of advance directives, most dialysis patients do not complete them. Current views of the advance care planning process emphasize that development of a specific written advance directive is only one small part of the process. ⋯ Successful advance care planning requires that dialysis care providers incorporate end-of-life care wishes and palliative care into the overall health care plans for their patients. This review focuses on the past impediments to achieving useful advance directives among dialysis patients and their families and provides some suggestions to improving this important aspect of dialysis patient care.
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Review Case Reports
Biliary peritonitis complicating percutaneous nephrostomy.
Biliary peritonitis is a rare but serious complication of percutaneous renal access and surgery. We present such a case and review the literature.