Clin Nephrol
-
Review Case Reports Comparative Study
Alkalinization and hemodialysis in severe salicylate poisoning: comparison of elimination techniques in the same patient.
We report the case of a man who took two overdoses of aspirin, on each occasion suffering a grand mal fit with blood levels of salicylate of over 5 mmol/l. The first event was treated with hemodialysis but without effective alkalinization, and the second with alkalinization but without hemodialysis. ⋯ Similar salicylate levels were achieved with both techniques by 24 hours post-overdose. If a case of salicylate poisoning is to be treated with hemodialysis, treatment with alkalinization should still be given without delay, in order to prevent acidemia and to promote elimination of as much salicylate as possible via the kidneys.
-
Review Comparative Study
Acetate free biofiltration (AFB): from theory to clinical results.
Acetate free biofiltration (AFB) is a hemodiafiltration technique based on a buffer-free dialysate and bicarbonate infusion in the postdilution mode. The performance of AFB requires a dialysis machine equipped with an automatic control system to balance the infusion rate to that of ultrafiltration. The filters employed are usually polyacrylonitrile hollow-fiber hemodialyzers. ⋯ However, it is not known whether these positive effects may entail better long-term prognosis; moreover, comparisons between AFB and conventional dialysis were never designed to ascertain the role of the dialysis membrane from that of the other components of AFB on clinical results. Therefore, large prospective trials with long observation periods are necessary to clarify the mechanisms through which AFB might be superior to conventional dialysis as well as the impact of these techniques on long-term prognosis. In such studies other relevant factors such as rehabilitation and life quality of the patients, which have been generally neglected in previous surveys, must also be included to evaluate cost-effectiveness of this therapy.
-
Vena cava diameter (VCD) measurement is an accepted method to evaluate hydration status in patients on hemodialysis. Bioelectrical impedance analysis (BIA) is a less laborious method to assess hydration variables and more suitable for routine patient care. However, BIA has not yet been validated in dialysis patients. We investigated whether BIA can replace VCD in patients on hemodialysis. ⋯ BIA can replace VCD only in major underhydration (VCD < 6.5 mm/m2). Fluid loss during hemodialysis is caused by a decrease of ECW, compatible with the postulation that excess fluid volume is carried by the extracellular compartment.
-
Antineutrophil cytoplasmic antibodies positivity with cytoplasmic pattern (C-ANCA) and proteinase-3 (PR-3) specificity was found in two patients with both subacute bacterial endocarditis (SBE) and glomerular involvement. Renal biopsy showed membranoproliferative glomerulonephritis in one case and focal segmental glomerulonephritis in the second case. ⋯ Physicians have to consider the possible occurrence of such C-PR-3 ANCA, claimed to be specific markers for Wegener's granulomatosis, in infectious diseases such as SBE. Hence we focus on the necessity of performing a renal biopsy with light microscopy and immunofluorescence studies in all patients with ANCA associated glomerular disease.
-
Decisions which determine the duration and outcome of terminal care should be influenced by patient autonomy. Studies suggest, however, that end-of-life decision-making is more complex than a single principle and that physicians may be responsible for selected aspects of terminal care independent of patient choice. To study how nephrologists' perceptions toward end-of-life issues may affect decision-making, we anonymously surveyed 125 of them. ⋯ Twenty-five percent of nephrologists admitted difficulty with advance directives if the directives clashed with heir beliefs. ESRD end-of-life decision-making in the USA may be altered by the subjective characteristics of nephrologists. In particular, nephrologists' level of discomfort with patient mortality is linked with their reported management of terminal patients.