Clin Nephrol
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Pain is a major health problem in end-stage renal disease (ESRD) affecting half of the dialysis patients; most of them experience a moderate to severe degree of pain. Nevertheless, the impact of chronic pain and its consequences are often underestimated. Sources of pain related to the uremic environment are renal bone disease (osteitis fibrosa cystica, amyloidosis, osteomalacia), osteoarthritis, calcific uremic arteriolopathy and peripheral neuropathy. ⋯ In the therapy of pain the WHO three-step analgesic ladder adapted for ESRD, was shown to be effective in dialysis patients. Of fundamental importance are various forms of non-pharmacological strategies including electrotherapy. Recently the so-called high tone external muscle stimulation (HTEMS) was very effective in the management of neuropathic pain in ESRD patients.
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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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In acute kidney injury (AKI), many cytokines are released by leukocytes and renal tubular cells in the injured kidney and are important components of both the initiation and extension of inflammation. Cytokines are 1) produced by the kidney and mediate AKI, 2) produced by the kidney, released into the blood or urine and serve as biomarkers of AKI, and 3) produced by the kidney or other organs in AKI and mediate or protect against distant organ injury. Further understanding of the role of cytokines in AKI may result in therapeutic approaches like cytokine inhibition that may reduce the degree of kidney injury itself, as well as deleterious effects of kidney injury on other organs.
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Review Case Reports
Purple urine bag syndrome: case report and literature review.
Purple urine bag syndrome (PUBS) is a medical syndrome in which there is purple discoloration of the urine of catheterized patients as well as discoloration of the collecting bag and the associated tubing. This rare condition, which mostly affects women, is generally associated with catheter-associated urinary tract infection, chronic constipation and alkaline urine. ⋯ The clinical course of PUBS is generally benign, and intensive treatment is not usually needed. We present 3 cases of this unusual and interesting phenomenon and a literature review.
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Acute kidney injury (AKI) is frequent in hospitalized critically ill patients and mortality associated with AKI is largely unchanged over many decades. The new nomenclature, AKI, reflects the entire spectrum of acute renal failure, recognizing that an acute decline in kidney function can be secondary to an injury that causes functional or structural changes in the kidneys [Mehta et al. 2007]. An abrupt change in serum creatinine level has been the primary method for diagnosing AKI for nearly 60 years despite its well recognized limitations [Addis et al. 1947, Barrett and Addis 1947, Fisher and Wilhelmi 1937, Star 1998]. ⋯ It is now widely believed that the availability of accurate and objective early biomarkers of AKI will stimulate progress in the development of early interventions in AKI. Recognition of this concept has led to a surge in preclinical, translational and clinical research for discovery and validation of biomarkers in AKI. In this review we will discuss the role of biomarkers in AKI and the promising biomarkers on the horizon.