Renal failure
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A 66-year-old diabetic man presented with severe right thigh swelling and pain together with acute renal failure. At autopsy, this was found to be due to disseminated high grade B cell lymphoma invading the psoas muscle and multiple organs, including the kidneys. The unique presentation of this case emphasizes the need for increased awareness of the variety of ways in which lymphoma can manifest itself.
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Renal ischemia/reperfusion (I/R)-induced tubular epithelial cell injury, called ischemic acute renal failure, is associated with high mortality in humans. Protecting the kidney against I/R injury is very important during complicated renal operations, transplantation surgery, and anesthesia. Aim. The purpose of this study was to investigate and compare the efficiency of ketamine, thiopental, propofol, etomidate, and intralipid in reducing the injury induced by free radicals in a rat model of renal I/R. ⋯ Our results demonstrated that I/R injury was significantly reduced in the presence of propofol and thiopental. The protective effects of these drugs may belong to their antioxidant properties. These results may indicate that propofol and thiopental anesthesia protects against functional, biochemical, and morphological damage better than control in renal I/R injury.
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Ischemia-reperfusion (I-R) injury remains the leading cause of acute renal failure. The purpose of this experimental study was to determine the role of dexmedetomidine on histologic alterations induced by renal I-R in rats. In the present study, thirty male Sprague-Dawley rats weighing 200-220 g were randomly assigned into three groups: the sham-control group (group 1, n = 10), the R/untreated group (group 2, n = 10), and the I-R/dexmedetomidine-treated group (group 3, n = 10). ⋯ In the I-R/untreated group rats, kidneys of untreated ischemia rats showed tubular cell swelling, cellular vacuolization, pyknotic nuclei, medullary congestion, and moderate to severe necrosis. Treatment with dexmedetomidine shows normal glomeruli and slight edema of the tubular cells. These findings provide the first evidence that dexmedetomidine can reduce the renal injury caused by I-R of the kidney, and may be useful in enhancing the tolerance of the kidney against renal injury.
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A female concurrently developed polymyositis (PM), lung cancer, and nephrotic range proteinuria. Renal biopsy revealed crescentic glomerulonephritis. Pathology of lung cancer was proved to be adenocarcinoma. ⋯ We consider that such association of PM and crescent glomerulonephritis is rare in adults. Careful evaluation of underlying malignancy is important. The definite treatment is adequate management of underlying malignancy.
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Comparative Study
Renal anemia: comparing current Eastern and Western European management practice (ORAMA).
The Optimal Renal Anaemia Management Assessment trial prospectively examined the impact of implementing European Best Practice Guidelines on outcomes in the management of renal anemia. Baseline data give an insight to standards of clinical care and provide a basis for a future comparison of guideline target attainment with final results. Fifty-three centers from eight European countries enrolled 739 patients with stage II-V chronic kidney disease who were either anemic (hemoglobin <11 g/dL) or treated with erythropoiesis-stimulating agents and/or iron supplementation. ⋯ The guideline ferritin target was achieved by 85% of dialysis and 52% of non-dialysis patients; 81% of dialysis and 78% of non-dialysis patients attained the transferrin saturation target. Most patients (96%) were receiving erythropoiesis-stimulating agents. Anemia management in patients with chronic kidney disease shows considerable regional differences across Europe, and target attainment remains suboptimal in many European nephrology centers after the revised 2004 guidelines.