Cleveland Clinic journal of medicine
-
Patients with an elevated serum creatinine or whose serum creatinine levels increase postoperatively, regardless of baseline levels, are at increased risk for elevated mortality. Women have a higher risk from acute renal failure than men at every level of serum creatinine. Acute renal failure confers an increased risk of mortality, chronic renal insufficiency, and postoperative infection independent of other postoperative complications. Preoperative measures to reduce risk of acute renal failure include optimizing volume and solute status, ensuring adequate urine flow, avoiding high doses of diuretics, optimizing hematocrit levels, and avoiding contrast agents.
-
Most patients with chronic kidney disease eventually become anemic. We should view the management of anemia in these patients as part of the overall management of the many clinically relevant manifestations of chronic kidney disease. Erythropoiesis-stimulating agents (ESAs) are safe and should be used, as treating anemia may forestall some of the target-organ damage of chronic kidney disease.
-
Case Reports
Perioperative management of the bariatric surgery patient: focus on cardiac and anesthesia considerations.
Obesity is a major public health problem in developed nations worldwide. Currently, the only treatment for severe obesity (BMI > or = 35 kg/m2 with comorbidity) that provides long-term weight loss is bariatric surgery. Restrictive, malabsorptive, and combination procedures have been developed. ⋯ Candidates for bariatric surgery are often at high risk for complications because of obesity-related comorbidities. Therefore, careful patient selection for bariatric surgery, together with well-designed strategies for preventing and managing complications, are keys to success. Close monitoring for nutritional deficiencies and short- and long-term complications is required to completely assess outcomes of these procedures.
-
Tumor necrosis factor (TNF) inhibitors have proven highly effective against a number of autoimmune diseases but have been disappointing in treating others. An increase in the risk of Mycobacterium tuberculosis and other opportunistic infections has been noted in patients treated with these agents. If we use these drugs, we need to weigh their beneficial and adverse effects.