Renal failure
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To describe long-term quality of life, intensive care, and hospital mortality in patients with acute renal and respiratory failure treated with one of two methods of renal replacement therapy (RRT). ⋯ (1) The method of RRT used in ICU patients with ARF had no influence on survival; (2) The long-term survivors of multi-organ failure have poor physical health.
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Comparative Study
Heparin-induced thrombocytopenia in patients administered heparin solely for hemodialysis.
Heparin, universally used in patients on dialysis, is the cause for immune-mediated heparin-induced thrombocytopenia (HIT). ⋯ HIT can occur in patients administered heparin solely for hemodialysis. When HIT is suspected, heparin should be discontinued and an alternative anticoagulation initiated. Argatroban, which is not renally cleared, supports continued renal replacement therapy in HIT patients.
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Identification of factors causing acute renal failure (ARF) and its associated poor prognosis in critically ill patients can help in planning strategies to prevent ARF and to prioritize the utilization of sparse and expensive therapeutic modalities. Most of the studies in such patients have been done in the developed world, and similar data from the developing world is sparse. We analyzed 45 consecutive patients who developed ARF in the intensive care unit (ICU) during a 12-month period. ⋯ On comparing the predictor outcomes between survivors and nonsurvivors by multivariate analysis, only the number of failed organs at the time of ARF (2.6 +/- 0.9 vs. 4.5 +/- 0.8) and serum albumin < 3.0 g/dL were found to be statistically significant. To conclude, ARF in critically ill patients is multifactorial in origin and carries a high mortality. Mortality in these patients increases with increasing numbers of failed organs and with a serum albumin of < 3.0 g/dL.
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Tubulointerstitial injury is both a key feature of diabetic nephropathy and an important predictor of renal dysfunction. N-Acetyl B glucosaminidase (NAG) is derived from proximal tubular cells and is widely used to evaluate tubular renal function. ⋯ Urinary NAG excretion is elevated in type II diabetic patients as compared with the healthy individuals. Perindopril/indapamide administration is effective in reducing urinary NAG excretion in these patients, and this effect seems to be independent from blood pressure and glycemia control. Presence of tubular proteinuria may be an early indicator of diabetic renal disease in patients without microalbuminuria. Perindopril (2 mg)/ indapamide (0.625 mg)/o.d. treatment may have beneficial effect on the tubulointerstitial damage in diabetic kidney disease.
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Comparative Study
Mortality risk factors and validation of severity scoring systems in critically ill patients with acute renal failure.
Risk stratification and prediction of outcome in acute renal failure patients in the intensive care unit are important determinants for improvement of patient care and design of clinical trials. ⋯ Cross-validation of prognostic models for ARF resulted in poor performance of all studied scores. Therefore, a specific model is still warranted for the design of clinical trials, comparison of studies, and for prediction of outcome in ARF patients, especially in the ICU.