Clin Nephrol
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Acute kidney injury (AKI) is costly and is associated with increased mortality and morbidity. An understanding of the renal physiologic changes that occur during pregnancy is essential for proper evaluation, diagnosis, and management of AKI. As in the general population, AKI can occur from prerenal, intrinsic, and post-renal causes. ⋯ For each of these disorders, delivery of the fetus is the recommended therapeutic option, with additional therapies indicated for each specific disease entity. An understanding of the various etiologies of AKI in the pregnant patient is key to the appropriate clinical management, prevention of adverse maternal outcomes, and safe delivery of the fetus. In pregnant women with pre-existing kidney disease, the degree of renal dysfunction is the major determining factor of pregnancy outcomes, which may further be complicated by a prior history of hypertension.
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We hypothesized that positive fluid balance (FB) is the result of intraoperative kidney injury and associated renal vasoconstriction, and therefore may be an early clinical indicator of acute kidney injury (AKI). Since rapid changes in fluid volume occur during cardiovascular (CV) surgery, we investigated the influence of immediate postoperative FB on AKI. ⋯ PosFB in the immediate postoperative period may be an independent early indicator of AKI in patients undergoing CV surgery.
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The extracellular domain of klotho is cleaved and released into various extracellular fluids, such as blood, urine, and cerebrospinal fluid, as soluble α-klotho (sαKl). ⋯ The sαKl level was lower in hemodialysis patients than in healthy persons. Serum P level was independently associated with the serum sαKl level.
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Severe hyponatremia is a serious medical condition that is associated with morbidity and mortality. Controversy still exists regarding the prevalence, cause and mortality of hyponatremia. ⋯ This study showed that the sodium level per se is not related to mortality, but a higher Charlson's risk index and a slow rate of correcting the sodium are related with mortality. For improving the survival of patients with severe hyponatremia, we should pay more attention to correct the underlying comorbidity.