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Diabetes Insipidus: A Pragmatic Approach to Management.

Diabetes insipidus (DI) is a disorder of water balance characterized by polyuria and polydipsia. It can occur due to genetic and acquired causes that affect the secretion or action of arginine vasopressin (AVP) or antidiuretic hormone (ADH).Markedly increased thirst and urination are not only quite distressing but also increases the risk of volume depletion and hypernatremia in severe situations. A careful diagnosis of the type of DI and its etiology is based on careful clinical evaluation, measurement of urine and serum osmolality, and water deprivation test. Management includes the correctio

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… Some patients may have transient CDI over 1-4 days, followed by a phase of oliguria (4-7 days) due to the release of stored AVP from degenerating neurons and then permanent DI with the destruction of the AVP-secreting neurons [ 6 ]. …

Case report: Light-chain amyloidosis responsive to selinexor in combination with daratumumab and dexamethasone (SDd) therapy.

The outcome of AL amyloidosis remains poor, particularly in patients with advanced organ involvement which takes long time to recovery. We conducted an observational study of two patients with AL amyloidosis treated with SDd regimen. Both patients successfully achieved significant hematological and organ responses without severe adverse events, and the time to organ response was remarkably shorter than previously reported. Notably, an over 15% reduction in interventricular septal thickness (IVST) was observed in patient#2 within 6 months. Up to now, SDd therapy has not been previously reported

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… A 67-year-old woman who had prior treatment of VD and VCD for her ligh-chain amyloidoisis (AL) and later underwent hemodialysis was referred to our hospital for further treatment in December 2021, with symptoms including dyspnea, facial oedema, small pericardial effusion, abdominal distension and oliguria …

Clinical guidelines of UTIs in children: quality appraisal with AGREE II and recommendations analysis.

OBJECTIVE: To explore the current Chinese and English guidelines of urinary tract infection (UTI) in children and provide a summary of the recommendations of the guidelines. METHODS: An electronic search was conducted on databases, including Pubmed, SinoMed, Wangfang Data, CHKD,VIP, NICE, WHO, GIN and Medliveto retrieve data of the clinical practice guidelines on UTI from the establishment of the database to June 2020. Four assessors assessed the quality of guidelines using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) and evaluated the specific recommendations in guidel

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… Table 4 Summary of recommendations *Not recommend RBUS during the febrile UTI, unless it is complicated, atypical or severe (presence of any of the following: septic state, fever persisting after 3 days of appropriate antibiotic treatment, elevated plasma creatinine, oliguria). …

Long-Term Outcome of Patients With a Hematologic Malignancy and Multiple Organ Failure Admitted at the Intensive Care.

ObjectivesHistorically, patients with a hematologic malignancy have one of the highest mortality rates among cancer patients admitted to the ICU. Therefore, physicians are often reluctant to admit these patients to the ICU. The aim of our study was to examine the survival of patients who have a hematologic malignancy and multiple organ failure admitted to the ICU.DesignThis retrospective cohort study, part of the HEMA-ICU study group, was designed to study the survival of patients with a hematologic malignancy and organ failure after admission to the ICU. Patients were followed for at least 1

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… Acute kidney injury was defined as the need for renal replacement therapy or a creatinine level greater than 133 µmol/L in combination with oliguria within 24 hours of admission to the ICU. …

Mutations in the alternative complement pathway in multiple myeloma patients with carfilzomib-induced thrombotic microangiopathy.

Thrombotic microangiopathy (TMA) has been reported to occur in multiple myeloma (MM) patients in association with treatment with carfilzomib, an irreversible proteasome inhibitor (PI). The hallmark of TMA is vascular endothelial damage leading to microangiopathic hemolytic anemia, platelet consumption, fibrin deposition and small-vessel thrombosis with resultant tissue ischemia. The molecular mechanisms underlying carfilzomib-associated TMA are not known. Germline mutations in the complement alternative pathway have been recently shown to portend increased risk for the development of atypical

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… Patient | Hgb (g/dL) | Platelet count (×10 9 /L) | Cr (mg/dL) | Baseline Cr (mg/dL) | LDH (U/L) | Anuria/Oliguria | GI sx | New HTN at time of TMA diagnosis | TMA confirmed by renal biopsy 1 | 7.7 | 30 | 2.0 | 0.65 | 619 | Y | N | Y | N 2 | 7.7 | 20 | 3.08 | 1.19 | 371 | Y | N | Y | N 3 | 13 | 31 | 1.04 …

Complete spectrum of adverse events associated with chimeric antigen receptor (CAR)-T cell therapies.

Chimeric antigen receptor (CAR)-T cell therapies have been approved by FDA to treat relapsed or refractory hematological malignancies. However, the adverse effects of CAR-T cell therapies are complex and can be challenging to diagnose and treat. In this review, we summarize the major adverse events, including cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and CAR T-cell associated HLH (carHLH), and discuss their pathophysiology, symptoms, grading, and diagnosis systems, as well as management. In a future outlook, we also provide an overview of

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… Table 5 Diagnosis criteria of CAR-T-cell-related HLH/MAS Ferritin level A peak serum ferritin level of > 10,000 ng/ml (during CRS phase) AND Clinical and Pathology (any two of the criteria) Grade ≥ 3 increase in serum bilirubin, aspartate aminotransferase, or alanine aminotransferase levels Grade ≥ 3 oliguria … 5 Diagnosis criteria of CAR-T-cell-related HLH/MAS Ferritin level | A peak serum ferritin level of > 10,000 ng/ml (during CRS phase) AND Clinical and Pathology (any two of the criteria) | Grade ≥ 3 increase in serum bilirubin, aspartate aminotransferase, or alanine aminotransferase levels Grade ≥ 3 oliguria …

Acute Kidney Injury in Oncology Patients.

With rapid progress in cancer diagnosis and treatment in the last two decades, outcomes in oncological patients have improved significantly. However, the incidence of acute kidney injury (AKI) in this population has also increased significantly. AKI complicates many aspects of patients' care and adversely affects their prognoses; thus, accurately diagnosing the risk factors for AKI ensures appropriate management. AKI may be caused by pre-renal, intrinsic renal, and post-renal reasons, as well as for combined reasons. This review summarizes the potential etiologies of AKI according to the three

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… Post-renal AKI Most patients with AKI have post-renal causes, and urinary tract obstruction (UTO) is the major cause of post-renal AKI; anuria or oliguria quickly follow UTO. …

A randomized phase III study of carfilzomib vs low-dose corticosteroids with optional cyclophosphamide in relapsed and refractory multiple myeloma (FOCUS).

This randomized, phase III, open-label, multicenter study compared carfilzomib monotherapy against low-dose corticosteroids and optional cyclophosphamide in relapsed and refractory multiple myeloma (RRMM). Relapsed and refractory multiple myeloma patients were randomized (1:1) to receive carfilzomib (10-min intravenous infusion; 20 mg/m2 on days 1 and 2 of cycle 1; 27 mg/m2 thereafter) or a control regimen of low-dose corticosteroids (84 mg of dexamethasone or equivalent corticosteroid) with optional cyclophosphamide (1400 mg) for 28-day cycles. The primary endpoint was overall survival (OS).

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… Grouped renal failure AEs (that is, azotemia, oliguria, renal failure, acute renal failure and renal impairment) occurred more frequently in patients in the carfilzomib group compared with the control group (24 vs 9%). …

Staged Correction of Severe Thoracic Kyphosis in Patients with Multilevel Osteoporotic Vertebral Compression Fractures.

Study Design Technical report. Objective Multilevel osteoporotic vertebral compression fractures may lead to considerable thoracic deformity and sagittal imbalance, which may necessitate surgical intervention. Correction of advanced thoracic kyphosis in patients with severe osteoporosis remains challenging, with a high rate of failure. This study describes a surgical technique of staged vertebral augmentation with osteotomies for the treatment of advanced thoracic kyphosis in patients with osteoporotic multilevel vertebral compression fractures. Methods Five patients (average age 62 ± 6 years)

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… To reduce these risks, only 30 mL of cement was injected per procedural stage. 31 32 Because fat embolism syndrome can develop 12 to 36 hours after surgery (e.g., petechial rash, tachypnea, dyspnea, tachycardia, pyrexia, oliguria, thrombocytopenia), 32 33 we waited at least 3 days before proceeding with …

Thrombotic microangiopathy in untreated myeloma patients receiving carfilzomib, cyclophosphamide and dexamethasone on the CARDAMON study.

Proteasome inhibitors have been associated with thrombotic microangiopathy (TMA) - a group of disorders characterised by occlusive microvascular thrombosis causing microangiopathic haemolytic anaemia, thrombocytopenia and end-organ damage. To date, carfilzomib-associated TMA has predominantly been described in relapsed/refractory myeloma patients. We report eight patients with newly diagnosed myeloma who experienced TMA events while receiving carfilzomib on the phase II CARDAMON trial. The first three occurred during maintenance single-agent carfilzomib, two occurred at induction with carfilzo

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… J. and Lipe, B. 21 | 3 | KR maintenance in 2/3 patients (Patient 1 K TCD = 464 mg; Patient 2 K TCD = 1826 mg) KCd in 1/3 patient (K TCD = 329 mg) | Thrombocytopenia, MAHA and AKI in all patients with diarrhoea and oliguria/anuria. …

Acute kidney injury in patients with newly diagnosed high-grade hematological malignancies: impact on remission and survival.

BackgroundOptimal chemotherapy with minimal toxicity is the main determinant of complete remission in patients with newly diagnosed hematological malignancies. Acute organ dysfunctions may impair the patient's ability to receive optimal chemotherapy.Design and methodsTo compare 6-month complete remission rates in patients with and without acute kidney injury (AKI), we collected prospective data on 200 patients with newly diagnosed high-grade malignancies (non-Hodgkin lymphoma, 53.5%; acute myeloid leukemia, 29%; acute lymphoblastic leukemia, 11.5%; and Hodgkin disease, 6%).ResultsAccording to

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… Variables | n (%) or median [IQR] RIFLE classification within 7 days after ICU admission | Risk | 37 (27) Serum creatinine (µmol/L) | 79 [65;98] Injury | 27 (19.7) Serum creatinine (µmol/L) | 117 [85;138] Failure | 73 (53.3) Serum creatinine (µmol/L) | 143 [86;244] Oliguria | 77 (56.2) Laboratory data …

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Multiple Myeloma Outpatient Transplant Program in the Era of Novel Agents: State-of-the-Art.

Multiple myeloma (MM) is the most common indication for autologous stem cell transplantation (ASCT), and outpatient models have been widely developed in this setting. Although numerous studies have demonstrated the safety and feasibility of outpatient ASCT, it is not a routine procedure. Stringent guidelines for patient selection and clinical management, including functional status, caregiver support, and psychological aspects, are essential to identify eligible patients. However, there is still no general agreement on these criteria. Quality of life data are limited and contradictory. There i

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… Suggested criteria for readmission are reported in Table 3 : hemodynamic instability (e.g., tachycardia and low blood pressure), impaired respiratory function (increased respiratory frequency and low oximetry on room air), oliguria, altered mental status and other signs of clinical instability ; Grade …

Synthetic nickel-containing superoxide dismutase attenuates para-phenylenediamine-induced bladder dysfunction in rats.

Para (p)-phenylenediamine and its toxic metabolites induce excess reactive oxygen species formation that results in bladder voiding dysfunction. We determined the effects of synthetic Ni-containing superoxide dismutase mimics and the role of oxidative stress in p-phenylenediamine-induced urinary bladder dysfunction. P-phenylenediamine (60 μg/kg/day) was intraperitoneally administered for 4 weeks to induce bladder injury in female Wistar rats. Synthetic Ni-containing superoxide dismutase mimics, WCT003 (1.5 mg/kg) and WCT006 (1.5 mg/kg), were then intraperitoneally administered for 2 weeks. Tra

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… Our data suggested that toxic metabolites from PPD might impair renal tubular cells by inhibiting water absorption, resulting in early stage diuresis and late-stage oliguria with damaged urothelial cells leading to frequent urination by undefined mechanisms. …

Chemotherapy-induced acute kidney injury: epidemiology, pathophysiology, and therapeutic approaches.

Despite significant advancements in oncology, conventional chemotherapy remains the primary treatment for diverse malignancies. Acute kidney injury (AKI) stands out as one of the most prevalent and severe adverse effects associated with these cytotoxic agents. While platinum compounds are well-known for their nephrotoxic potential, other drugs including antimetabolites, alkylating agents, and antitumor antibiotics are also associated. The onset of AKI poses substantial risks, including heightened morbidity and mortality rates, prolonged hospital stays, treatment interruptions, and the need for

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… Clinically, AKI may present with oliguria or anuria, and most cases are attributed to ATI, as confirmed by biopsy ( 4 , 139 – 141 ). A possible mechanism is direct nephrotoxicity following repeated exposure to the drug. … Case report and supporting documentation: acute kidney injury manifested as oliguria is reduced by intravenous magnesium before cisplatin. Front Oncol. (2021) 11:607574. doi: 10.3389/fonc.2021.607574 74. Konishi H, Fujiwara H, Itoh H, Shiozaki A, Arita T, Kosuga T, et al. …

Тенденции смертности от почечной недостаточности среди многих пациентов в возрасте от миэломы ≥ 45 годы, 1999-2023Анализ данных ЦКЗ.

Множественная миелома (ММ) — плазменная порча клеток, которая часто осложняется почечным расстройством, что значительно ухудшает прогноз. Несмотря на то, что терапевтический прогресс улучшил выживание ММ, почечная недостаточность по-прежнему является одной из основных причин неблагоприятных последствий. В этом исследовании были рассмотрены долгосрочные тенденции и демографические различия в показателях смертности среди лиц, умерших в США, при этом ММ была названа основной причиной смерти и почечной недостаточности, которая была названа одной из причин смертности. Данные о смертности среди взро

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… Notably, about 10% of patients present with severe renal failure or oliguria/anuria at the time of diagnosis 3 . …

Carfilzomib-lenalidomide-dexamethasone vs lenalidomide-dexamethasone in relapsed multiple myeloma by previous treatment.

Carfilzomib, a proteasome inhibitor, is approved as monotherapy and in combination with dexamethasone or lenalidomide-dexamethasone (Rd) for relapsed or refractory multiple myeloma. The approval of carfilzomib-lenalidomide-dexamethasone (KRd) was based on results from the randomized, phase 3 study ASPIRE (NCT01080391), which showed KRd significantly improved progression-free survival (PFS) vs Rd (median 26.3 vs 17.6 months; hazard ratio (HR)=0.690; P=0.0001). This subgroup analysis of ASPIRE evaluated KRd vs Rd by number of previous lines of therapy and previous exposure to bortezomib, thalido

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… , increased troponin T, acute coronary syndrome, abnormal cardiac stress test, cardiomyopathy stress, unstable angina, coronary artery stenosis, abnormal electrocardiogram ST-T segment and abnormal electrocardiogram T wave. c Included: acute renal failure, renal failure, renal impairment, azotemia, oliguria …

Carfilzomib, lenalidomide, and dexamethasone in patients with relapsed multiple myeloma categorised by age: secondary analysis from the phase 3 ASPIRE study.

A primary analysis of the ASPIRE study found that the addition of carfilzomib to lenalidomide and dexamethasone (carfilzomib group) significantly improved progression-free survival (PFS) compared with lenalidomide and dexamethasone alone (control group) in patients with relapsed multiple myeloma (RMM). This post hoc analysis examined outcomes from ASPIRE in patients categorised by age. In the carfilzomib group, 103/396 patients were ≥70 years old, and in the control group, 115/396 patients were ≥70 years old. Median PFS for patients Trial registrationclinicaltrials.gov identifier: NCT01080391.

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… stress test, cardiomyopathy stress, unstable angina, coronary artery stenosis, abnormal electrocardiogram ST‐T segment and abnormal electrocardiogram T wave. c The category of acute renal failure included (in descending order of frequency) acute renal failure, renal failure, renal impairment, azotemia, oliguria …

Targeted treatments of bone metastases in patients with lung cancer.

Until now ~30-40% of patients with advanced lung cancer develop bone metastases, but as the newer therapies are extending survival, the chance of developing bone metastases increases. Bone metastases cause skeletal-related events (SREs) such as pathologic fractures, spinal cord compression, radiation therapy or surgery to bone, or hypercalcemia, which can have debilitating consequences affecting patients' health-related quality of life (HR-QOL) and performance status (PS). Poor PS then prevents the patients to receive further lines of treatments, which are available today. SREs are associated

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… Table 2 Adverse events of interest . a Includes blood creatinine increased, renal failure, renal failure acute, proteinuria, blood urea increased, renal impairment, urine output decreased, anuria, oliguria, azotemia, hypercreatininemia, creatinine renal clearance decreased, renal failure chronic, blood …

Comprehensive Updates in the Role of Imaging for Multiple Myeloma Management Based on Recent International Guidelines.

The diagnostic and treatment methods of multiple myeloma (MM) have been rapidly evolving owing to advances in imaging techniques and new therapeutic agents. Imaging has begun to play an important role in the management of MM, and international guidelines are frequently updated. Since the publication of 2015 International Myeloma Working Group (IMWG) criteria for the diagnosis of MM, whole-body magnetic resonance imaging (MRI) or low-dose whole-body computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography/CT have entered the mainstream as diagnostic and treatment respons

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… Renal insufficiency is seen in 20–40% of newly diagnosed MM cases, but patients rarely present with dysuria or oliguria. Compared to other CRAB criteria, hypercalcemia is less common in MM, seen in up to 13% of patients. …