Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/diagnosis , Kidney Failure, Chronic/complications , Pneumonia, Viral/diagnosis , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/virology , Female , Humans , Kidney Failure, Chronic/therapy , Middle Aged , Pandemics , Peritoneal Dialysis , Pneumonia, Viral/complications , Pneumonia, Viral/virology , SARS-CoV-2ABSTRACT
ADH is a hormone secreted by neurohypophysis that plays different roles based on the target organ. At the renal level, this peptide is capable of causing electrolyte-free water absorption, thus playing a key role in the hydro-electrolytic balance. There are pathologies and disorders that jeopardize this balance and, in this field, ADH receptor inhibitors such as Vaptans could play a key role. By inhibiting the activation pathway of vasopressin, they are potentially useful in euvolemic and hypervolemic hypotonic hyponatremia. However, clinical trials in heart failure have not given favourable results on clinical outcomes. Even in SIADH, despite their wide use, there is no agreement by experts on their use. Since vaptans inhibit the cAMP pathway in tubular cells, their use has been proposed to inhibit cystogenesis. A clinical trial has shown favourable effects on ADPKD progression. Because vaptans have been shown to be effective in models of renal cysts disorders other than ADPKD, their use has been proposed in diseases such as nephronophthisis and recessive autosomal polycystic disease. Other possible uses of vaptans could be in kidney transplantation and cardiorenal syndrome. Due to the activity of ADH in coagulation and haemostasis, ADH's activation pathway by Desmopressin Acetate could be a useful strategy to reduce the risk of bleeding in biopsies in patients with haemorrhagic risk.
Subject(s)
Antidiuretic Hormone Receptor Antagonists/therapeutic use , Kidney Diseases/drug therapy , Molecular Targeted Therapy , Neurophysins/agonists , Neurophysins/antagonists & inhibitors , Protein Precursors/agonists , Protein Precursors/antagonists & inhibitors , Receptors, Vasopressin/drug effects , Vasopressins/agonists , Vasopressins/antagonists & inhibitors , Water-Electrolyte Imbalance/drug therapy , Antidiuretic Hormone Receptor Antagonists/pharmacology , Cadaver , Cyclic AMP/physiology , Forecasting , Humans , Hyponatremia/drug therapy , Hyponatremia/physiopathology , Kidney Diseases/physiopathology , Kidney Diseases, Cystic/drug therapy , Kidney Transplantation , Kidney Tubules, Collecting/drug effects , Kidney Tubules, Collecting/physiology , Neurophysins/physiology , Polycystic Kidney, Autosomal Dominant/drug therapy , Polycystic Kidney, Autosomal Dominant/physiopathology , Protein Precursors/physiology , Receptors, Vasopressin/agonists , Second Messenger Systems/drug effects , Tissue Donors , Vasopressins/physiologyABSTRACT
INTRODUCTION: Arteriovenous fistula (AVF) salvage procedures play a crucial role in the care of the uremic patient, influencing quality of life and overall survival. In this study, we report on our centre's experience and analyse the outcomes, in terms of cumulative patency, of surgical salvage procedures on complicated AVFs. METHODS: Our study included patients who underwent surgical salvage procedures of their AVFs in our centre from 22/12/2009 to 29/12/2011. Early and late salvage procedures were analysed separately. RESULTS: Of 617 vascular access procedures, 136 salvage procedures were performed, 24 of which were defined as early and 112 as late. Among salvage procedures, re-anastomosis was the most frequently performed, (37.2%), followed by AVF declotting (34.1%) and aneurysm removal (14.0%). Cumulative patency at 3, 6, and 12 months were 91%, 83% and 77% respectively. CONCLUSIONS: Our study shows that surgical salvage procedures are a viable option for complicated AVFs, providing optimal short- and long-term results in terms of patency.
