Clin Nephrol
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Multicenter Study Clinical Trial
Role of calcium channel blockers in diabetic renal transplant patients: preliminary observations on protection from sepsis.
Diabetic recipients of kidney transplants have an excessively high risk of allograft loss, infectious complications with sepsis, cardiovascular events and early death. This study was designed in order to determine whether post-transplantation medical management influenced long-term results. ⋯ Allograft success and patient survivals may be improved and sepsis related events diminished when diabetic renal allograft recipients are treated with calcium channel blocking agents, plus or minus beta blockers. Considerable savings can be accomplished and graft results with these drugs can approach non-diabetic and live-related transplant results.
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Comparative Study
Percutaneous renal biopsy of ventilated intensive care unit patients.
The etiology of acute renal failure in ventilated intensive care unit patients can be determined non-invasively in more than 80% of cases. When a pulmonary renal syndrome is suspected however it is important to obtain histological confirmation of the diagnosis prior to initiating therapy. Most text books and review articles have advocated the use of open surgical biopsy in this situation. ⋯ We compare the complication rate with that achieved using open surgical biopsy during the same time period. The complication rate using a percutaneous technique was similar to open renal biopsy. We believe that the previously held recommendation that percutaneous renal biopsy should not be performed on ventilated patients should be re-examined.
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Comparative Study
Transesophageal echocardiographic assessment of superior vena cava thrombosis in patients with long-term central venous hemodialysis catheters.
In some patients with end-stage renal failure, arteriovenous fistulas cannot be created due to poor vessel conditions. Alternatively, hemodialysis (HD) can be performed using long-term central venous catheters. However, these dialysis catheters are associated with a presently unknown risk of superior vena cava (SVC) thrombosis. ⋯ Reduced blood flow during HD was observed in 5 of 7 patients with catheter-associated thrombi but also in 4 of 13 patients without evidence for caval thrombosis by TEE. It is concluded that thrombotic occlusion of the SVC is frequent in patients with long-term central venous access; it does not necessarily correlate with clinical signs but can easily be detected by TEE. Patients with long-term central venous hemodialysis catheters should undergo transesophageal echocardiography at regular intervals.
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Continuous renal replacement therapies are extensively utilized for the treatment of acute renal failure in the critically ill patient. The arterio-venous circulation has been partially substituted by the veno-venous pump driven circulation. Diffusion has been added to convection in order to increase the small solutes clearance even though sometimes the pure convection is still advantageously utilized. ⋯ The improved understanding of the multiple organ failure syndrome and the pathophysiology of the septic syndrome, suggest today newer indications for continuous renal replacement therapies. The proposed mechanisms of action of the therapy should be the removal of chemical mediators such as platelet activating factor, interleukin-1 and tumor necrosing factor alfa, not only by a filtration process, but also by the adsorption on the surface and structure of the artificial membrane. These new mechanisms may in part be responsible for the beneficial effects of continuous therapies in the patients affected by acute renal failure and other organ dysfunctions.