Journal of nephrology
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Journal of nephrology · Jul 2003
Comparative StudyContinuous renal replacement therapies: anticoagulation in the critically ill at high risk of bleeding.
The ongoing necessity for systemic heparinization is a well-known disadvantage of continuous renal replacement therapies (CRRT), and alternative methods of anticoagulation may be required. Our aim was to evaluate, in patients with a high risk of bleeding, the possibility of an acceptable filter life with non-anticoagulation CRRT and, in case of early filter failure, the efficacy and safety of bedside monitored regional anticoagulation with heparin and protamine. ⋯ Non-anticoagulation CRRT allowed an adequate filter life in most patients with a high risk of bleeding for prolonged aPTT and/or thrombocytopenia. Despite concerns regarding the need for careful monitoring, regional anticoagulation with heparin and protamine can be considered as a safe and valid alternative when non-anticoagulation is unsuitable because of early filter failure.
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Journal of nephrology · Jul 2003
Role of serum creatinine and prognostic scoring systems in assessing hospital mortality in critically ill cirrhotic patients with upper gastrointestinal bleeding.
End-stage liver disease is frequently complicated by episodes of gastrointestinal hemorrhage that are often associated with multiple organ dysfunction and require intensive care. This study aimed to identify specific predictors of hospital mortality in critically ill cirrhotic patients with gastrointestinal bleeding, and compare the prediction accuracy of the Child-Pugh score and two illness severity scoring systems frequently used for intensive care unit (ICU) patients. ⋯ The rise of serum Cr levels above 1.5 mg/dL is common, and indicates a poor prognosis for critically ill cirrhotic patients with gastrointestinal bleeding. SOFA is a straightforward approach with excellent prognostic abilities for this homogeneous patient subset.
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Journal of nephrology · May 2003
ReviewPortuguese-type amyloidosis (transthyretin amyloidosis, ATTR V30M).
Portuguese-type amyloidosis (transthyretin amyloidosis, ATTR V30M) is the most common form of systemic hereditary amyloidosis, inherited in autosomal dominant mode. The disease, also called familial amyloid polyneuropathy type I (FAP-I), is caused by a mutant transthyretin (TTR) protein, which is synthesized by the liver. A single amino acid substitution of methionine for valine at position 30 of the TTR molecule (TTR V30M) was found in Portuguese patients. ⋯ The progression towards end-stage renal disease (ESRD) affects 10% of the patients, and the survival after initiation of dialysis is a mean of 21 months. Patients who progress to ESRD have a late onset of neuropathy and lower prevalence of clinical disease in their families. Liver transplantation is a widely accepted treatment for FAP-I, and combined liver-kidney transplantation is also an option for selected patients with FAP-I and ESRD.
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Journal of nephrology · May 2003
Non-heart-beating donors: experience from the Hospital Clinico of Madrid.
Non-heart-beating donors (NHBD) have received attention in the last few years as an alternative source to increase the pool of kidney donors. The majority of reports focus on NHBD from controlled donors, i.e. patients who die in hospital. This report focuses on our experience using uncontrolled NHBD, i.e. patients who die outside of hospital and are transported to hospital for organ donation. ⋯ At 2 years renal function post-transplantation was better in NHBD organs, as evaluated by serum creatinine and creatinine clearance, while after 2 years it was similar. The incidence of acute renal rejection was lower in NHBD; however, delayed graft function, as expected, was more prevalent in NHBD, although interestingly it did not influence long-term survival. In conclusion NHBD from deaths outside the hospital may be a good source of donor kidneys and also a way to successfully increase the pool for organ transplantation.
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The clinical spectrum of monogenic renal diseases is wide ranging, from autosomal dominant polycystic kidney disease to very rare inherited disorders. The genes involved in most of these diseases have been identified. ⋯ The challenges of the future will be to understand phenotypic variability and the molecular mechanisms of disease, and to design pharmacological tools to stop or retard its progression. The post-gene era has begun and the field of research in monogenic disorders is wide open.