Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Mar 2022
[Epidemiology and Causes of Acute Renal Failure and Transition to Chronic Kidney Disease].
Acute kidney injury (AKI) refers to an acute functional deterioration of the kidneys, which leads to retention of urinary substances, dysregulation of the electrolyte and acid-base balance, and disturbance of fluids. Although didactically helpful, the oversimplified AKI classification of prerenal/renal/postrenal is currently considered obsolete. Indeed, the boundaries blur quite quickly, particularly between prerenal and renal causes. ⋯ Persisting AKD for > 90 days is classified as CKD. The transition from AKD to CKD is the result of an incomplete and maladaptive repair process. Although follow-up of post-AKI patients is essential, optimal concepts still need to be developed.
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Osteoarthritis (OA) is a very common disease. As a consequence of the ageing society, osteoarthritis prevalence will further increase. Age itself, trauma, unequal load distribution and overweight are risk factors. ⋯ With the current non-approval of the nerve growth factor (NGF)-antibody tanezumab, a new therapeutical option for OA suffered a setback. Unfortunately, the results of the phase 2 study on the Wnt inhibitor lorecivivint are barely encouraging. However, the results of the according phase 3 study are eagerly awaited.
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The increasing interruptions of night sleep with normal ageing must be distinguished from sleep disorders. Somatic and psychiatric morbidity as well as medication have a huge impact on sleep. Furthermore, the relationship between sleep and morbidity is mutual. Disturbed sleep modifies the clinical appearance of diseases and morbidity affects the ability to sleep. Especially in geriatric medicine, geriatric syndromes such as falls, depression or dementia are modified by sleep disorders. ⋯ Sleep medicine provides further technical methods for further examination. Older people should also be examined in a sleep laboratory if the results have consequences that will be accepted by the patient. However, this should be clarified in advance.
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Acute kidney injury (AKI) represents one of the greatest global health challenges and is associated with high mortality. The often multifactorial etiology and complex pathophysiological mechanisms have so far hampered the development of causal therapeutic options. ⋯ New insights into the influence of mitochondrial dysfunction and cellular senescence in AKI, well-defined study endpoints, and innovations through nanotechnology may enable targeted drug-based AKI therapy in the future. Especially the weeks following an AKI are a vulnerable phase and crucial for progression management.
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Acute kidney injury contributes significantly to morbidity and mortality in hospitalized patients and is a common complication in the intensive care unit. Identification of patients at risk, elimination of modifiable risk factors and initiation of recommended preventive measures are the main cornerstones to prevent the onset and progression of acute kidney injury. Clinical and biomarker-based risk scores can help assess AKI-risk in specific patient populations. ⋯ Nephrotoxic drugs require a critical risk-benefit assessment and therapeutic drug monitoring when appropriate. Contrast imaging should not be withheld from patients at risk of AKI when indicated but contrast medium should be limited to the smallest possible volume. Finally, recommendations include maintenance of normoglycemia and other measures to optimize organ function in specific patient populations.