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  • ISSN: 2573-1637
    Volume 1, Issue 1
    Case Report
    Rodolfo Fernando Rivera*, Luca Di Lullo, Antonio De Pascalis, Fulvio Floccari, Antonio Bellasi, Giancarlo Joli, and Maria Teresa Sciarrone Alibrandi
    Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic disorder in nephrology. Two genes have been implicated in the development of the disease: PKD1 on chromosome 16 (85%) and PKD2 on chromosome 4 (15%). ADPKD is clinically characterized by renal and extra renal involvement expressed with the onset of cystic and non-cystic manifestations. Since cardiovascular complications are leading cause of morbidity and mortality, this review aims to analyze cardiac and vascular involvement in ADPKD.
    Hypertension is a common early symptom, and occurs in approximately 60% of patients before renal dysfunction. The effect of hypertension on the progression to end-stage renal disease makes it the most important potentially treatable risk factor in ADPKD. Left ventricular hypertrophy also occurs frequently in these patients representing another powerful and independent risk factor for cardiovascular morbidity and mortality in ADPKD. Other abnormalities such as biventricular diastolic dysfunction, endothelial dysfunction and increased carotid intima media thickness are present even in young ADPKD patients with normal blood pressure and well-preserved renal function. Intracranial and extra cranial aneurysms and cardiac valvular defects are other common cardiovascular manifestations in patients with ADPKD. Early treatment of hypertension through the use of renin-angiotensin-aldosterone system blocking agents could play a nephroprotective effect and reduce the occurrence of cardiovascular complications in ADPKD patients.
    John Mellas*
    Background: Acute Kidney Injury (AKI) is a common and serious condition encountered in hospitalized patients. The severity of kidney injury is defined by the RIFLE, AKIN, and KDIGO criteria which attempt to establish the degree of renal impairment. The KDIGO guidelines state that the creatinine clearance should be measured whenever possible in AKI and that the serum creatinine concentration and creatinine clearance remain the best clinical indicators of renal function. Neither the RIFLE, AKIN, nor KDIGO criteria estimate actual creatinine clearance. Furthermore there are no accepted methods for accurately estimating creatinine clearance in AKI.
    The present study describes a new, unique, and simple method for estimating K in AKI using urine creatinine excretion over an established time interval (E), an estimate of creatinine production over the same time interval (P), and the estimated static glomerular filtration rate (sGFR), at time zero, utilizing the CKD-EPI formula. Using these variables estimated creatinine clearance (Ke) = E/P * sGFR.
    Patient examples are provided to highlight the use of this method and its advantage over AKIN, RIFLE, or KDIGO which have the above mentioned shortcomings while often incorrectly classifying the extent of renal injury in the patient with AKI.
    Conclusions: The present study provides the practitioner with a new tool to estimate real time K in AKI with enough precision to predict the severity of the renal injury, including progression, stabilization, or improvement in azotemia. It is the author's belief that this simple method improves on RIFLE, AKIN, and KDIGO for estimating the degree of renal impairment in AKI and allows a more accurate estimate of K in AKI.
    Research Article
    Awad Magbri*, Patricia McCartney, Eussera El-Magbri, Mariam El-Magbri, and Taha El-Magbri
    Background and objectives: Access monitoring and pre-emptive angioplasty is known to decrease the incidence of AVF/AVG thrombosis. Thrombosis is the leading cause of vascular access complications and is almost always associated with the presence of stenosis. Percutaneous transluminal angioplasty (PTA) is an accepted treatment of stenotic lesions in AV access. The purpose of this study is to assess the effect of follow up of ESRD patients in the dialysis access center with preemptive angioplasty on access thrombosis.
    Design, setting, participants, & measurements: This is a single center observational interventional study extended over 9 years (Jan 1, 2006 to Dec 31, 2014) at the Dialysis Access Center of Pittsburgh (DAC), PA. The study is divided into 2 periods, period A (from Jan 2006 to December 2009), where follow up program was not in place. Period B extends from (January 1, 2011 to December 31, 2014). In this period, a follow up of patients with preemptive angioplasty of AV access has been implemented. All patients with ESRD on HD are seen in DAC for access monitoring and interventional PTA if deemed necessary.
    Results: During period A; a total of 4139 encounters with a mean of 1034, (1653 angioplasties with mean of 413/year, 375 angiogram, mean 94/year, and 303 thrombectomies of AVF/AVG with a mean 76/year) were carried out. Thrombectomies constituted (7.3%) of the total procedures performed.
    In period B, a total of 6229 encounters with mean of 1557 encounter/year were performed, (3202 angioplasties, mean 801/year, 950 angiograms, mean 238/year, and 196 thrombectomies, mean 42/year) were done. Thrombectomies were decreased almost 2 folds in this period (7.3% to 3.15%).
    The percentage of patients being dialyzed via TDC decreased in period B from 31.895% to 17.38%. The numbers of thrombectomies have also been decreased from average 76 to 42 /year (7.3% to 3.15%).
    The frequency of thrombectomies (3.15% vs. 9.6%) and TDC use (17.38% vs. 18%), have showed significant improvement. Meanwhile, the number of PTA has doubled from an average of (413 to 801/year) between the 2 periods.
    Conclusion: Follow up of ESRD patients in the DAC and preemptive angioplasty if need be is an acceptable means to decrease the number of failed accesses, thrombectomies, as well as the use of TDC in ESRD patients.
    Arthur Roux, Christine Fumeron, Thierry Petitclerc, and Caroline Creput*
    Introduction: Daily Online Hemodiafiltration (D-OL-HDF), by combining OL-HDF and daily hemodialysis, is an interesting alternative modality for ESKD patients. First results were reported by Fischbach et al., on children and by Maduell et al., on adult's patients in 2003: excellent clinical tolerance and better dialysis adequacy allowing a better quality of life, an improvement in nutritional status, a better control of anemia and blood pressure and a reduction of left ventricular mass were reported. However, there is no data regarding this technique since 2003. We studied here retrospectively ten patients treated with D-OL-HDF and followed them during twelve-months to evaluate the benefits of this modality.
    Materiel and Methods: All 10 patients, treated with D-OL-HDF between 2011 and 2015 in our centre, were included in this study. Data were collected monthly after changing three times a week OL-HDF to D-OL-HDF (six or five times a week, 2 to 2.5 hours by session respectively): dialysis adequacy, hemodynamic and cardiovascular parameters, bone's parameters and nutritional status have been evaluated.
    Results and Discussion: As expected, the Interdialytic Weight Gain (IDWG) was significantly lower as well as the value of Brain Natriuretic Peptid (BNP) and, in meanwhile, a gain in Left Ventricular Ejection Fraction (LVEF) after twelve months was obtained. We observed also a significant increase in haemoglobin value and in serum albuminemia whereas other parameters remained stable. Moreover, phosphate binders and oral calcium supplementation were reduced during the follow-up.
    Discussion: These benefits are consistent with those presented by Maduell et al: D-OL-HDF seems to be an excellent technique and should be considered as an alternative treatment to three times a week conventional treatment.
    Review Article
    Theodore J. McMenomy, Mehgan Holland, Nilto C. de Oliveira, James D. Maloney, Richard D. Cornwell, and Keith C. Meyer*
    Lung transplant recipients may develop profound renal dysfunction due to Stage IV kidney disease following successful lung transplantation (LTX). A comprehensive medical record review was performed for all LTX recipients transplanted from 1988 to 2012 to identify patients who subsequently underwent renal transplantation (RTX) for end-stage renal insufficiency. Sixteen LTX recipients underwent subsequent RTX (6 males, 10 females) at an average of 8.3 years (median 8, range 3-15) following LTX. Forced expiratory volume in 1 second (FEV1) obtained 6-12 months following RTX declined by more than 10% versus stable pre-RTX FEV1 values in only 4 recipients, and no recipients experienced new onset of BOS post-RTX. We conclude that RTX should be considered for those LTX recipients who develop chronic, end-stage renal failure, and that RTXcan be performed safely in LTX recipients without significant impact on lung allograft function.
    Short Communication
    Zhuang Haifeng* and Gao Ruilan
    Renal anemia results from not only relative or absolute insufficiency of erythropoietin (EPO) caused by different kinds of kidney diseases, but also some toxic substances in uremia patients’ plasma which are interfered with production and metabolism of RBC [1]. It is one of the major complications of chronic renal failure (CRF). Its extent is positively correlated with renal hypofunction degree. Renal anemia can occur when chronic glomerular filtration function decreases by more than 50 percent. Renal anemia has high incidence in crowd with chronic kidney disease (CKD). Its effective treatment has a great influence on CRF patients’ prognosis and their life quality. If renal anemia is untreated or improper treated, it may cause many kinds of physiological abnormalities, including oxygen transport and reduction in tissue oxygen utilization, increase of cardiac output, cardiac enlargement, ventricular hypertrophy, angina, heart failure, decline of cognitive ability, allergy, menstrual disorder, sexual dysfunction, and decline of immune function and so on. Therefore, correction of renal anemia posses an important clinical significance.
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