Renal failure
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There have been many studies to estimate the incidence of acute kidney injury (AKI) in critically ill patients. However, results were variable due to the non-usage of uniform criteria and retrospective design of most studies. There are no new studies from the developing countries looking at AKI in these patients since adoption of uniform Acute Kidney Injury Network (AKIN) criteria. ⋯ Older patients, those with septic shock, and those requiring prolonged mechanical ventilation had increased risk for AKI. AKI was an independent predictor of mortality.
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Comparative Study
Combination of renal biomarkers predicts acute kidney injury in critically ill adults.
Most studies so far have focused on the performance of individual biomarkers to detect early acute kidney injury (AKI) in the adult intensive care unit (ICU) patients; however, they have not determined the predictive ability of their combinations. The aim of this study was to compare the predictive abilities of plasma neutrophil gelatinase-associated lipocalin (pNGAL), urine neutrophil gelatinase-associated lipocalin (uNGAL), plasma cystatin C (pCysC), serum creatinine (sCr), and their combinations in detecting AKI in an adult general ICU population. ⋯ The biomarker combinations had better predictive characteristics compared with those of each biomarker alone.
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Intensity of dialysis dose in acute kidney injury (AKI) might benefit critically ill patients. The aim of this study was to evaluate the effect of intermittent hemodialysis (IHD) dose on mortality in patients with AKI. ⋯ Higher dialysis doses can be associated with better survival of less seriously ill AKI patients.
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Comparative Study
Major barriers against renin-angiotensin-aldosterone system blocker use in chronic kidney disease stages 3-5 in clinical practice: a safety concern?
Renin-angiotensin-aldosterone system (RAAS) blockers are underutilized in patients with chronic kidney disease (CKD). We aimed to determine barriers against the use of RAAS blockers in these patients. Patients with stage 3-5 CKD referred to Hacettepe University Hospital Nephrology Unit during a 1 year period were evaluated for RAAS blocker use. ⋯ In 37.4% of patients, reasons for not starting RAAS blockers were unclear. This study showed that hyperkalemia is the major barrier against the use of RAAS blockers in patients with CKD. There was, however, a subset of patients who did not receive RAAS blockers even without clear contraindications.
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In this report, the clinical characteristics of a 65-year-old female patient with tricuspid regurgitation, ischemic cardiomyopathy, congestive heart failure, and chronic renal failure were retrospectively evaluated. Laboratory studies revealed cardiogenic ascites coincided with nephrogenic ascites and subclinical amiodarone-induced hypothyroidism. The ascites of the patient was responsive to management of congestive heart failure and therapeutic paracentesis during the first episode, add-on therapy with intensified hemodialysis during the second episode, and add-on therapy with low-dose eltroxin during the third episode. When nephrogenic ascites and cardiogenic ascites of maintenance hemodialysis patients become refractory, hypothyroidism should be examined in these patients.