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[Renal markers and predictors, and renal and cardiovascular risk factors].

An important task of the nephrologists during the last century, it has been the search of elements and means that allow us, with the adequate precision, to correlate the functional deterioration of the kidney, and the patient's clinical reality. And the continuous searching of factors and markers that injure them, the prognosis, and early diagnosis, to be able to predict the degree of the organs and patient's survival. Almost parallel survival presage in the natural history of the illness, almost one century ago. In the second half of the XX century, in the developed countries, appear modifica…

Kidney care in patients with cancer: perspectives from the onconephrology committee of the Brazilian Society of Nephrology.

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… The most robust was the American Society of Onconephrology (ASON), launched in the US in 2021, including nephrologists from multiple countries worldwide. … The committee gathers nephrologists with expertise in the care of cancer patients. …

Optimizing Prescribing for Individuals With Type 2 Diabetes and Chronic Kidney Disease Through the Development and Validation of Algorithms for Community Pharmacists.

BACKGROUND: Diabetes is the leading cause of kidney disease and contributes to 38% of kidney failure requiring dialysis. A gap in detection and management of type 2 diabetes (T2D) in chronic kidney disease (CKD) exists in primary care. Community pharmacists are positioned to support those not able to access kidney care through traditional pathways. Algorithms were developed and validated to assist community pharmacists in identifying individuals with T2D in CKD and prescribing kidney-protective medications. OBJECTIVE: The objective was to develop and validate pharmacist algorithms to confirm

Clinician's use of automated reports of estimated glomerular filtration rate: a qualitative study.

BackgroundThere is a growing awareness in primary care of the importance of identifying patients with chronic kidney disease (CKD) so that they can receive appropriate clinical care; one method that has been widely embraced is the use of automated reporting of estimated glomerular filtration rate (eGFR) by clinical laboratories. We undertook a qualitative study to examine how clinicians use eGFR in clinical decision making, patient communication issues, barriers to use of eGFR, and suggestions to improve the clinical usefulness of eGFR reports.MethodsOur study used qualitative methods with str

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… Is there something more we’re missing, before we send them to the nephrologist and they go on dialysis? What if we’re missing a multiple myeloma or vasculitis, which can be treated before they were sent to the nephrologist. … Interaction between nephrologists and primary care physicians would appear to play an important role in how eGFRs are utilized. …

Optimal predialysis care.

Management of severe chronic kidney disease (CKD) involves dealing with medical, nursing and psychosocial problems and therefore warrants support from a multidisciplinary team. In the Kidney Disease Outcomes Quality Initiative (KDOQI) classification system of CKD, preparation for renal replacement therapy has been recommended in CKD stage 4, characterized by a reduction in the estimated glomerular filtration rate (GFR) of <30 ml/min. In this article we share our approach to perfecting predialysis care. Tools are given to make an estimation of the progression of kidney disease. Also the prevent

Management of cytotoxic chemotherapy in patients undergoing dialysis: a still unresolved issue of onconephrology.

The incidence of tumors increases significantly in individuals with chronic kidney disease (CKD), particularly among those undergoing dialysis. This dialysis-associated condition not only impacts therapy but also influences the prognosis of oncological patients, contributing to heightened mortality rates related to both cancer and non-cancer causes. Importantly, it stands as a primary factor leading to suboptimal utilization of therapies. Dosage adjustment for many types of chemotherapy is a necessity in patients with kidney impairment. However, due to a lack of comprehensive knowledge about t

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… For these patient categories, a multidisciplinary approach involving nephrologists, oncologists/hematologists, and pharmacologists is recommended. … Many patients on dialysis are often denied appropriate treatment due to an already mentioned nihilistic attitude, not only among oncologists but also, regrettably, among nephrologists. …

Factors affecting survival in advanced chronic kidney disease patients who choose not to receive dialysis.

INTRODUCTION: Non-dialytic treatment (NDT) has become a recognized and important modality of treatment in end stage renal disease (ESRD) in … nts approaching end stage chronic kidney disease who chose not to dialyse were recruited from other nephrologists. The study group was classified according to age band (<70 years, 71-80 years, and >80 years), estimated glomerular filtration rate (eGFR) (<10 ml/min, 11-20 ml/min, and >20 ml/min) according to the Modified Diet In Renal Disease formula and Stoke c …

Treating anemia of chronic kidney disease in the primary care setting: cardiovascular outcomes and management recommendations.

Anemia is an underrecognized but characteristic feature of chronic kidney disease (CKD), associated with significant cardiovascular morbidity, hospitalization, and mortality. Since their inception nearly two decades ago, erythropoiesis-stimulating agents (ESAs) have revolutionized the care of patients with renal anemia, and their use has been associated with improved quality of life and reduced hospitalizations, inpatient costs, and mortality. Hemoglobin targets >/=13 g/dL have been linked with adverse events in recent randomized trials, raising concerns over the proper hemoglobin range for ES

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… Nephrologists bear a formidable share of the responsibility for managing advanced CKD [ 24 ] and frequently become sole providers of primary care to dialysis patients [ 25 ]. The ratio of dialysis recipients to nephrologists is predicted to exceed 160:1 by 2010 [ 24 ]. … Patients with an eGFR below 30 mL/min/1.73 m 2 are considered appropriate for referral to a nephrologist, and many PCPs and nephrologists prefer a higher eGFR referral trigger as Stage 3 approaches. …

Predictors of functional health status of end stage renal disease patients.

Potential predictors of the functional health status of 125 end stage renal disease (ESRD) patients were studied cross-sectionally. When health status was assessed by the physician with the Karnofsky Index, younger patient age, lower ESRD severity of illness, lower comorbidity severity, and higher albumin levels were predictors of better health [R-square = 0.48]. When patients self-reported their health status with the Duke Health Profile, African-American race, higher family support, lower family stress, and lower ESRD severity were positive predictors [R-square = 0.23]. The importance of mea

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… Introduction Should nephrologists measure and monitor the functional health status (i.e., health-related quality of life) of their ESRD patients? … As a result of the HSO Group's efforts to encourage nephrologists to look more closely at the practical application of health status measures, the authors (RG, a nephrologist and GP, one of the developers of the DUKE), performed the study reported here to take an in-depth snapshot of the health status …

Light Chain (AL) Amyloidosis: The Journey to Diagnosis.

BackgroundLight chain (AL) amyloidosis is a rare, complex disease associated with significant morbidity and mortality. Delays in diagnosis are common and may have detrimental consequences on patients' prognosis. Too little is known regarding the patient journey to diagnosis.ObjectiveThe objective of this study was to describe the patient-reported journey to a correct diagnosis for AL amyloidosis.MethodsUsing a mixed-methods approach, data were collected from clinician (n = 4) and patient (n = 10) interviews and a survey of community-based patients with AL amyloidosis (n = 341). Data were used

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… As described in Table 4 , the types of specialty consultations depended on the patients’ organ involvement and included primary care physicians, cardiologists, hematologists, nephrologists, gastroenterologists, pulmonologists, and others. … It is plausible that when patients receive abnormal urinalysis results they may be more likely to see a nephrologist who will order a kidney biopsy much earlier in the diagnostic journey than other patients. …

An approach to treating older adults with chronic kidney disease.

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… The Kidney Failure Risk Equation is a useful tool in the evaluation of and ongoing treatment for CKD for both general practitioners and nephrologists. … Nephrologists may initiate an erythropoietin-stimulating agent to target a hemoglobin range between 100 and 110 g/L. 32 Higher targets may be aimed for in patients with limited survival, but this brings with it a small risk of thrombosis and stroke events. …

A 57-Year-Old Female Presenting With Cardiopulmonary Arrest Secondary to Severe Hypokalemia From a Fanconi-Like Syndrome: A Case Report.

Fanconi syndrome is a multi-factorial disorder that involves diffuse malfunction of the proximal convoluted tubule in the kidney. Renal wasting of potassium, glucose, bicarbonate, amino acids, and phosphorus characterize the condition. We report a case of a 57-year-old female who presented to our emergency department with cardiopulmonary arrest. After successful resuscitation, she had extensive workup to uncover the cause of her cardiac arrest. She had extensive negative workup but was found to have severely low potassium, prompting further evaluation. She was noted to have elevated urine pota

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… Therefore, this condition often necessitates a multidisciplinary approach, including the involvement of nephrologists, endocrinologists, and cardiologists in order to navigate the complex diagnostic process successfully. … After a discussion with the primary team, the attending nephrologist started amiloride and sacubitril-valsartan to assist with reducing urinary losses of potassium. …

Cov-hep study: heparin in standard anticoagulation based on citrate for continuous veno-venous hemodialysis in patients with COVID-19: a structured summary of a study protocol for a randomized controlled trial.

OBJECTIVES: The primary objective is to test if heparin added to a standard regional anticoagulation protocol based on citrate is able to re … therapy in daily ICU rounds. Continuous renal replacement therapy will be prescribed by consulting nephrologists based on standard clinical guidelines, including acute kidney injury with hemodynamic instability plus hyperkalemia, severe acidosis, volume overload, respiratory distress, multiorgan failure or some combination of these factors. DATA COLLECTION: P …

Risk of percutaneous renal biopsy of native kidneys in the evaluation of acute kidney injury.

BackgroundPercutaneous renal biopsy (PRB) of native kidneys (NKs) to better understand and treat acute kidney injury (AKI) is being advocated, but little is known about the risk of complications.MethodsWe performed a retrospective study of PRB of NKs in 955 adults from 1991 to 2015 at an academic medical center with real-time ultrasound and automated biopsy needles. Patients undergoing PRB for evaluation of AKI (n = 160) were compared with 795 patients biopsied for other reasons (not-AKI) for postbiopsy complications [need for transfusion of packed red blood cells (PRBCs), an interventional ra

Light Chain Amyloidosis: Patient Experience Survey from the Amyloidosis Research Consortium.

IntroductionInformation detailing the experience of patients with light chain (AL) amyloidosis is lacking. The primary aim of this study was to gather data on the patient experience to understand the challenges in diagnosis and to gain insight into barriers to accessing appropriate care.MethodsPatients with amyloidosis, family members, and caregivers were invited to participate in an online 16-question survey (available from January 29 to February 5, 2015). Participants with AL amyloidosis were sent an eight-question follow-up survey.ResultsThe initial survey was completed by 533 participants

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… Respondents were then often referred for a second visit to a cardiologist (24.5%), hematologist/oncologist (16.5%), nephrologist (18.1%), or gastroenterologist (14.6%) (Fig. 1 ). … Nephrologists and cardiologists provided the correct diagnosis for 22.6% and 18.7% of respondents, respectively (Table 2 ). …

Impact of Kidney Failure Risk Prediction Clinical Decision Support on Monitoring and Referral in Primary Care Management of CKD: A Randomized Pragmatic Clinical Trial.

Rationale & objectiveTo design and implement clinical decision support incorporating a validated risk prediction estimate of kidney failure in primary care clinics and to evaluate the impact on stage-appropriate monitoring and referral.Study designBlock-randomized, pragmatic clinical trial.Setting & participantsTen primary care clinics in the greater Boston area. Patients with stage 3-5 chronic kidney disease (CKD) were included. Patients were randomized within each primary care physician panel through a block randomization approach. The trial occurred between December 4, 2015, and December 3,

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… The outcome was assessed in patients regardless of whether they had seen a nephrologist in the preceding 12 months and was assessed at a 6-month timepoint after the primary care visit ( Fig S5 ). … Outcomes in patients with chronic kidney disease referred late to nephrologists: a meta-analysis Am J Med 120 12 2007 1063 1070 10.1016/j.amjmed.2007.04.024 18060927 4 Stroupe K.T. Fischer M.J. Kaufman J.S. …

Real-World Outcomes of Patients with Monoclonal Gammopathy of Renal Significance.

BACKGROUND: Monoclonal gammopathy of renal significance (MGRS) is a rare group of renal disorders caused by monoclonal immunoglobulins from non-malignant B-cell or plasma cell clones, with distinct amyloid (MGRS-A) and non-amyloid (MGRS-NA) subtypes. Although these are often grouped together, whether they share similar clinical phenotypes and outcomes is uncertain. We therefore examined similarities and differences between these subtypes in a contemporary real-world cohort. METHODS: We performed a single-centre retrospective evaluation of 17 biopsy-confirmed MGRS patients (10 MGRS-A, 7 MGRS-N

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… The diagnostic pathway for MGRS typically involves collaboration between nephrologists and haematologists. … Often the diagnosis of MGRS is made by nephrologists after a renal biopsy, prompted by unexplained proteinuria, haematuria, or declining renal function in the presence of a monoclonal gammopathy. …

Взгляды пациентов и группы по уходу за почками на лечащую нагрузку и способность пожилых людей с хроническими заболеваниями почек: качественное исследование.

ЦЕЛЬ: Хроническая болезнь почек (КХД) часто является множественным заболеванием, а прогрессирование к более серьезным заболеваниям, как правило, связано с увеличением потребностей в управлении, включая изменение образа жизни, увеличение количества медикаментов и расширение участия клинических работников. В ходе этого исследования были изучены взгляды группы по уходу за пациентами и почками на характер и масштабы этой рабочей нагрузки (нагрузка на лечение), а также факторы, способствующие укреплению способности (способности управлять здоровьем) пожилых людей, имеющих ККД. DESIGN: Качественное п

Primary Health Care approach to managing chronic kidney disease.

Chronic kidney disease (CKD) is a growing global health issue among ageing populations, driven by increasing diabetes and hypertension. Managing advanced stages of CKD with dialysis or transplants is costly. Early stages often have no symptoms, making early detection important for prevention. Primary care providers can help identify and manage CKD early by performing annual screening for high-risk patients, including blood pressure checks, urine tests for albuminuria or proteinuria and estimating glomerular filtration rate from serum creatinine. For those with CKD, renal protective measures ar

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… While those progressing to ESKD require specialised care, such as transplantation, dialysis or sometimes palliation, these costs have a substantial impact on the healthcare system. 7 In South Africa, there are approximately two nephrologists per million people, which is below the global standard and … All suspected cases of glomerular disease require serological testing. 3 , 10 Specialist referral Primary care physicians are essential in making timely referrals to nephrologists, enabling early intervention to slow CKD progression and prepare patients for KRT. …

Severe Acute Kidney Injury in Hospitalized Cancer Patients: Epidemiology and Predictive Model of Renal Replacement Therapy and In-Hospital Mortality.

BackgroundAcute kidney injury (AKI) is a common complication among cancer patients, often leading to longer hospital stays, discontinuation of cancer treatment, and a poor prognosis. This study aims to provide insight into the incidence of severe AKI in this population and identify the risk factors associated with renal replacement therapy (RRT) and in-hospital mortality.MethodsThis retrospective cohort study included 3201 patients with cancer and severe AKI admitted to a Comprehensive Cancer Center between January 1995 and July 2023. Severe AKI was defined according to the KDIGO guidelines as

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… Our study reflects the incidence of severe AKI, but it is limited to cases followed by a nephrologist, which may partially explain the substantially lower overall incidence. … Whether obstructive AKI should be managed by nephrologists remains controversial. …