Clin Nephrol
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In the current political environment, the plight of undocumented immigrants in the United States (U. S.) remains perilous and uncertain, and this precarious situation is magnified for undocumented immigrants with end-stage renal disease (ESRD). For this population, access to hemodialysis varies dramatically from standard-of-care thrice-weekly hemodialysis, to the other extreme of emergency-only hemodialysis which is the practice of offering hemodialysis only after a patient meets "critically ill criteria." Due to the exclusion from Medicare, undocumented immigrants are not included in the United States Renal Data System (USRDS), and therefore the prevalence of undocumented immigrants with ESRD in the U. ⋯ Hispanics with Medicare to undocumented immigrants would likely overestimate the undocumented immigrant population with ESRD given the younger age of the immigrant population. Applying the estimates from the states with the largest population of undocumented immigrants, the range for California and Texas is 500 - 798 PMP which results in an estimate of 5,500 - 8,857 undocumented immigrants with ESRD living in the U. S.
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Contrast-induced acute kidney injury (CI-AKI) is a major complication after coronary angiography (CAG) or percutaneous coronary intervention (PCI) and is associated with increased morbidity and mortality. It remains controversial whether renin-angiotensin system (RAS) blockers increase or decrease CI-AKI. In this meta-analysis, we investigated the association between RAS blockers and CI-AKI in patients with normal kidney function or mild-to-moderate chronic kidney disease (CKD). ⋯ In patients with relatively-preserved renal function, the association of RAS blockers with an increased risk of CI-AKI after contrast media exposure was inconclusive, as sensitivity analysis showed conflicting results and bias. Although this study did not demonstrate significant evidence, it indicated that clinicians need to be vigilant in assessing the potential risk for RAS blockers to cause CI-AKI in low-risk patients.
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Review Case Reports
Chronic tubulointerstitial kidney disease in untreated adenine phosphoribosyl transferase (APRT) deficiency: A case report .
Adenine phosphoribosyltransferase (APRT) deficiency (OMIM #614723) is a rare autosomal recessive defect in the purine salvage pathway that causes excessive production of 2,8-dihydroxyadenine, leading to nephrolithiasis and chronic kidney disease (CKD). This case report describes the natural history of CKD in untreated APRT deficiency. We describe a novel APRT mutation (chr16:88877985 G / C; c.195 C>/G; p. ⋯ APRT deficiency is associated with slowly progressive CKD that occurs independently of nephrolithiasis. Diagnosis should be considered in all individuals with chronic tubulointerstitial kidney disease, with or without the presence of nephrolithiasis. In our patient, allopurinol 300 mg/day resulted in improvement of kidney function. .
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Anticancer drug-induced kidney disease is a problem commonly encountered by nephrologists. The number of medications employed by oncologists causing acute and chronic kidney injury as well as electrolyte and acid-base disturbances has increased significantly over the past several decades. While conventional chemotherapeutic drugs induce a number of kidney lesions, emergence of very effective and well-tolerated targeted therapies and novel immunotherapies has increased the occurrence of drug-induced acute and chronic kidney injury in cancer patients. This article will review the various kidney lesions observed with these new classes of anticancer drugs. .
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Review Meta Analysis
Low-dose versus high-dose heparin locks for hemodialysis catheters: a systematic review and meta-analysis.
Low-dose heparin lock has been suggested as an effective and safe catheter lock in hemodialysis. However, whether a low-dose lock is superior to a high-dose heparin lock in preventing catheter-related infections and maintaining catheter patency is inconclusive. ⋯ Low-dose heparin lock could decrease the incidences of catheter-related infections and bleeding-related complications without influencing the catheter retention time or the incidence of catheter thrombosis/occlusion or catheter dysfunction. Low-dose heparin lock solution should be recommended for the hemodialysis patients using central venous catheter in clinic.